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Hashimoto S, Nagoshi N, Nakamura M, Okano H. Clinical application and potential pluripotent effects of hepatocyte growth factor in spinal cord injury regeneration. Expert Opin Investig Drugs 2024:1-8. [PMID: 38783527 DOI: 10.1080/13543784.2024.2360191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 05/22/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Spinal cord injury (SCI) is a condition in which the spinal cord parenchyma is damaged by various factors. The mammalian central nervous system has been considered unable to regenerate once damaged, but recent progress in basic research has gradually revealed that injured neural cells can indeed regenerate. Drug therapy using novel agents is being actively investigated as a new treatment for SCI. One notable treatment method is regeneration therapy using hepatocyte growth factors (HGF). AREA COVERED HGF has pluripotent neuroregenerative actions, as indicated by its neuroprotective and regenerative effects on the microenvironment and damaged cells, respectively. This review examines these effects in various phases of SCI, from basic research to clinical studies, and the application of this treatment to other diseases. EXPERT OPINION In regenerative medicine for SCI, drug therapies have tended to be more likely to be developed compared to cell replacement treatment. Nevertheless, there are still challenges to be addressed for these clinical applications due to a wide variety of pathology and animal experimental models of basic study, but HGF could be an effective treatment for SCI with expanded application.
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Affiliation(s)
- Shogo Hashimoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hideyuki Okano
- Department of Physiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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Klamruen P, Suttiwong J, Aneksan B, Muangngoen M, Denduang C, Klomjai W. Effects of Anodal Transcranial Direct Current Stimulation With Overground Gait Training on Lower Limb Performance in Individuals With Incomplete Spinal Cord Injury. Arch Phys Med Rehabil 2024; 105:857-867. [PMID: 37926224 DOI: 10.1016/j.apmr.2023.09.025] [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: 12/19/2022] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To determine the effects of anodal transcranial direct current stimulation (tDCS) combined with overground gait training on gait performance, dynamic balance, sit-to-stand performance, and quality of life in individuals with incomplete spinal cord injuries (iSCI). DESIGN Double-blind sham-controlled trial with a matched-pair design. SETTING Sirindhorn National Medical Rehabilitation Institute, Thailand. PARTICIPANTS Individuals with iSCI (n=34) were allocated to the anodal or sham groups. INTERVENTION Anodal tDCS was administered over the M1 lower-limb motor area at an intensity of 2 mA for 20 min in the anodal group, while the sham group received a 30-s stimulation. Both groups received 40 min of overground gait training after tDCS for 5 consecutive daily sessions. MAIN OUTCOME MEASURES The 10-meter walk test (10MWT) was the primary outcome, while spatiotemporal gait parameters, the timed Up and Go test, Five-Time Sit-to-Stand Test, and World Health Organization Quality of Life-BREF were secondary outcomes. Outcomes were assessed at baseline, post-intervention, and at 1-month (1M) and 2-month (2M) follow-ups. RESULT Improvements in walking speed measured using the 10MWT were observed in both groups. However, the anodal group showed a greater improvement than the sham group. For fast speed, the mean between-group differences were 0.10 m/s, 95% CI (0.02 to 0.17) (post-intervention), 0.11 m/s, (0.03 to 0.19) (1M), and 0.11 m/s, (0.03 to 0.20) (2M), while for self-selected speed, the median differences were 0.10 m/s, 95% CI (0.06 to 0.14) (post-intervention) and 0.09 m/s, (0.01 to 0.19) (2M). The anodal group also had a greater stride length difference post-intervention (median difference: 0.07 m, 95% CI (0.01 to 0.14)). No significant between-group differences were found for other outcomes. CONCLUSION Five-session of anodal tDCS with gait training slightly improved walking speed, sustained for 2 months post-intervention. However, effect on spatiotemporal gait parameters was limited and dynamic balance, functional tasks (ie, sit-to-stand), and quality of life were unaffected compared with overground gait training.
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Affiliation(s)
- Pipat Klamruen
- Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand; Neuro Electrical Stimulation Laboratory (NeuE), Mahidol University, Nakhon Pathom, Thailand; Physical Therapy Unit, Sirindhorn National Medical Rehabilitation Institute, Nonthaburi, Thailand
| | - Jatuporn Suttiwong
- Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Benchaporn Aneksan
- Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand; Neuro Electrical Stimulation Laboratory (NeuE), Mahidol University, Nakhon Pathom, Thailand
| | - Monticha Muangngoen
- Physical Therapy Unit, Sirindhorn National Medical Rehabilitation Institute, Nonthaburi, Thailand
| | - Chanapass Denduang
- Physical Therapy Unit, Sirindhorn National Medical Rehabilitation Institute, Nonthaburi, Thailand
| | - Wanalee Klomjai
- Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand; Neuro Electrical Stimulation Laboratory (NeuE), Mahidol University, Nakhon Pathom, Thailand
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Wang D, Zhang X, Xin C, Wang C, Yue S, Guo D, Wang W, Zhang Y, Xu F. Electroencephalography-based biological and functional characteristics of spinal cord injury patients with neuropathic pain and numbness. Front Neurosci 2024; 18:1356858. [PMID: 38751860 PMCID: PMC11094546 DOI: 10.3389/fnins.2024.1356858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 04/08/2024] [Indexed: 05/18/2024] Open
Abstract
Objectives To identify potential treatment targets for spinal cord injury (SCI)-related neuropathic pain (NP) by analysing the differences in electroencephalogram (EEG) and brain network connections among SCI patients with NP or numbness. Participants and methods The EEG signals during rest, as well as left- and right-hand and feet motor imagination (MI), were recorded. The power spectral density (PSD) of the θ (4-8 Hz), α (8-12 Hz), and β (13-30 Hz) bands was calculated by applying Continuous Wavelet Transform (CWT) and Modified S-transform (MST) to the data. We used 21 electrodes as network nodes and performed statistical measurements of the phase synchronisation between two brain regions using a phase-locking value, which captures nonlinear phase synchronisation. Results The specificity of the MST algorithm was higher than that of the CWT. Widespread non-lateralised event-related synchronization was observed in both groups during the left- and right-hand MI. The PWP (patients with pain) group had lower θ and α bands PSD values in multiple channels of regions including the frontal, premotor, motor, and temporal regions compared with the PWN (patients with numbness) group (all p < 0.05), but higher β band PSD values in multiple channels of regions including the frontal, premotor, motor, and parietal region compared with the PWN group (all p < 0.05). During left-hand and feet MI, in the lower frequency bands (θ and α bands), the brain network connections of the PWP group were significantly weaker than the PWN group except for the frontal region. Conversely, in the higher frequency bands (β band), the brain network connections of the PWP group were significantly stronger in all regions than the PWN group. Conclusion The differences in the power of EEG and network connectivity in the frontal, premotor, motor, and temporal regions are potential biological and functional characteristics that can be used to distinguish NP from numbness. The differences in brain network connections between the two groups suggest that the distinct mechanisms for pain and numbness.
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Affiliation(s)
- Dezheng Wang
- Rehabilitation and Physical Therapy Department, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xinting Zhang
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Chen Xin
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Chongfeng Wang
- International School for Optoelectronic Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan, China
| | - Shouwei Yue
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Dongju Guo
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Wei Wang
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yang Zhang
- Rehabilitation and Physical Therapy Department, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Fangzhou Xu
- International School for Optoelectronic Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan, China
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Tekumalla A, Raj V. Letter to the Editor in regards to the article "Prognosticating acute traumatic spinal cord injury using Neurofilament (NF), Neuron Specific Enolase (NSE), Matrix Metalloproteinases (MMPs), and S-100B as biomarkers". Ir J Med Sci 2024:10.1007/s11845-024-03691-9. [PMID: 38639841 DOI: 10.1007/s11845-024-03691-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 04/12/2024] [Indexed: 04/20/2024]
Affiliation(s)
| | - Vikash Raj
- All India Institute of Medical Science, Deoghar, India
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Martinache F, Foudhaïli A, Vigué B. Early rehabilitation after spinal cord injury: a scoping review protocol. JBI Evid Synth 2024:02174543-990000000-00294. [PMID: 38602049 DOI: 10.11124/jbies-22-00461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
OBJECTIVE The objective of this scoping review is to identify the timings and types of early rehabilitation after spinal cord injuries (SCI) that are documented in the literature, as well as identify possible research gaps in this field. INTRODUCTION Preclinical and clinical studies support the idea that early rehabilitation may be beneficial for patients with acute SCI. However, the timing and types of rehabilitation that should and could be used in the acute stage are still unclear. The first step towards such knowledge is to extensively review what is documented in the literature. INCLUSION CRITERIA This review will consider all papers focusing on early rehabilitation after SCI in adult humans or animals (<3 months post-SCI for humans and other primates and <3 weeks post-SCI for other animals). Interventions in the included papers must aim at sensorimotor or functional improvement and take place in a hospital or a rehabilitation center if they target human subjects. METHODS MEDLINE (PubMed), Scopus, Embase (Embase.com), PEDro, Web of Science Core Collection, CINAHL (EBSCOhost), Cochrane Database of Systematic Reviews, Cochrane CENTRAL, PROSPERO, ClinicalTrials.gov, and gray literature sources will be searched for eligible articles. This review will include published and unpublished experimental and observational studies, research protocols, conference abstracts, systematic reviews, and guidelines. No language or date limits will be applied. Two independent reviewers will perform study selection and data extraction, and the results will be presented according to the SCI type and severity. REVIEW REGISTRATION Open Science Framework https://osf.io/q45er.
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Affiliation(s)
- Florence Martinache
- Université Paris-Saclay, CIAMS, 91405, Orsay, France
- Techno Concept, Manosque, France
- Département d'Anesthésie Réanimation, Service de Rééducation Post-Réanimation (SRPR), AP-HP, CHU de Bicêtre, 94275, Le-Kremlin-Bicêtre, France
| | - Adéla Foudhaïli
- Département de Médecine Physique et Réadaptation, AP-HP, CHU Lariboisiére, F-75010, Paris, France
- Université Paris Cité, Inserm, MASCOT, F-75010 Paris, France
- Université Paris Cité, Institut des Sciences du Sport-Santé de Paris, F-75015 Paris, France
| | - Bernard Vigué
- Département d'Anesthésie Réanimation, Service de Rééducation Post-Réanimation (SRPR), AP-HP, CHU de Bicêtre, 94275, Le-Kremlin-Bicêtre, France
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Dominguez-Bajo A, Clotman F. Potential Roles of Specific Subclasses of Premotor Interneurons in Spinal Cord Function Recovery after Traumatic Spinal Cord Injury in Adults. Cells 2024; 13:652. [PMID: 38667267 PMCID: PMC11048910 DOI: 10.3390/cells13080652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
The differential expression of transcription factors during embryonic development has been selected as the main feature to define the specific subclasses of spinal interneurons. However, recent studies based on single-cell RNA sequencing and transcriptomic experiments suggest that this approach might not be appropriate in the adult spinal cord, where interneurons show overlapping expression profiles, especially in the ventral region. This constitutes a major challenge for the identification and direct targeting of specific populations that could be involved in locomotor recovery after a traumatic spinal cord injury in adults. Current experimental therapies, including electrical stimulation, training, pharmacological treatments, or cell implantation, that have resulted in improvements in locomotor behavior rely on the modulation of the activity and connectivity of interneurons located in the surroundings of the lesion core for the formation of detour circuits. However, very few publications clarify the specific identity of these cells. In this work, we review the studies where premotor interneurons were able to create new intraspinal circuits after different kinds of traumatic spinal cord injury, highlighting the difficulties encountered by researchers, to classify these populations.
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Affiliation(s)
- Ana Dominguez-Bajo
- Université catholique de Louvain, Louvain Institute of Biomolecular Science and Technology (LIBST), Animal Molecular and Cellular Biology Group (AMCB), Place Croix du Sud 4–5, 1348 Louvain la Neuve, Belgium
| | - Frédéric Clotman
- Université catholique de Louvain, Louvain Institute of Biomolecular Science and Technology (LIBST), Animal Molecular and Cellular Biology Group (AMCB), Place Croix du Sud 4–5, 1348 Louvain la Neuve, Belgium
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Javeed S, Zhang JK, Greenberg JK, Botterbush K, Benedict B, Plog B, Gupta VP, Dibble CF, Khalifeh JM, Wen H, Chen Y, Park Y, Belzberg A, Tuffaha S, Burks SS, Levi AD, Zager EL, Faraji AH, Mahan MA, Midha R, Wilson TJ, Juknis N, Ray WZ. Impact of Upper Limb Motor Recovery on Functional Independence After Traumatic Low Cervical Spinal Cord Injury. J Neurotrauma 2024. [PMID: 38062795 DOI: 10.1089/neu.2023.0140] [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: 04/07/2024] Open
Abstract
Cervical spinal cord injury (SCI) causes devastating loss of upper limb function and independence. Restoration of upper limb function can have a profound impact on independence and quality of life. In low-cervical SCI (level C5-C8), upper limb function can be restored via reinnervation strategies such as nerve transfer surgery. The translation of recovered upper limb motor function into functional independence in activities of daily living (ADLs), however, remains unknown in low cervical SCI (i.e., tetraplegia). The objective of this study was to evaluate the association of patterns in upper limb motor recovery with functional independence in ADLs. This will then inform prioritization of reinnervation strategies focused to maximize function in patients with tetraplegia. This retrospective study performed a secondary analysis of patients with low cervical (C5-C8) enrolled in the SCI Model Systems (SCIMS) database. Baseline neurological examinations and their association with functional independence in major ADLs-i.e., eating, bladder management, and transfers (bed/wheelchair/chair)-were evaluated. Motor functional recovery was defined as achieving motor strength, in modified research council (MRC) grade, of ≥ 3 /5 at one year from ≤ 2/5 at baseline. The association of motor function recovery with functional independence at one-year follow-up was compared in patients with recovered elbow flexion (C5), wrist extension (C6), elbow extension (C7), and finger flexion (C8). A multi-variable logistic regression analysis, adjusting for known factors influencing recovery after SCI, was performed to evaluate the impact of motor function at one year on a composite outcome of functional independence in major ADLs. Composite outcome was defined as functional independence measure score of 6 or higher (complete independence) in at least two domains among eating, bladder management, and transfers. Between 1992 and 2016, 1090 patients with low cervical SCI and complete neurological/functional measures were included. At baseline, 67% of patients had complete SCI and 33% had incomplete SCI. The majority of patients were dependent in eating, bladder management, and transfers. At one-year follow-up, the largest proportion of patients who recovered motor function in finger flexion (C8) and elbow extension (C7) gained independence in eating, bladder management, and transfers. In multi-variable analysis, patients who had recovered finger flexion (C8) or elbow extension (C7) had higher odds of gaining independence in a composite of major ADLs (odds ratio [OR] = 3.13 and OR = 2.87, respectively, p < 0.001). Age 60 years (OR = 0.44, p = 0.01), and complete SCI (OR = 0.43, p = 0.002) were associated with reduced odds of gaining independence in ADLs. After cervical SCI, finger flexion (C8) and elbow extension (C7) recovery translate into greater independence in eating, bladder management, and transfers. These results can be used to design individualized reinnervation plans to reanimate upper limb function and maximize independence in patients with low cervical SCI.
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Affiliation(s)
- Saad Javeed
- Department of Neurological Surgery, Washington University, St. Louis, Missouri, USA
| | - Justin K Zhang
- Department of Neurological Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Jacob K Greenberg
- Department of Neurological Surgery, Washington University, St. Louis, Missouri, USA
| | - Kathleen Botterbush
- Department of Neurological Surgery, Washington University, St. Louis, Missouri, USA
| | - Braeden Benedict
- Department of Neurological Surgery, Washington University, St. Louis, Missouri, USA
| | - Benjamin Plog
- Department of Neurological Surgery, Washington University, St. Louis, Missouri, USA
| | - Vivek P Gupta
- Department of Neurological Surgery, Washington University, St. Louis, Missouri, USA
| | - Christopher F Dibble
- Department of Neurological Surgery, Washington University, St. Louis, Missouri, USA
| | - Jawad M Khalifeh
- Department of Neurological Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Huacong Wen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yuying Chen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yikyung Park
- Division of Public Health Sciences, Department of Surgery, Washington University, St. Louis, Missouri, USA
| | - Allan Belzberg
- Department of Neurological Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sami Tuffaha
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Stephen Shelby Burks
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Allan D Levi
- Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
| | - Eric L Zager
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Amir H Faraji
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Mark A Mahan
- Department of Neurological Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Rajiv Midha
- Department of Clinical Neurosciences, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Thomas J Wilson
- Department of Neurosurgery, Stanford University, Palo Alto, California, USA
| | - Neringa Juknis
- Physical Medicine and Rehabilitation, Washington University, St. Louis, Missouri, USA
| | - Wilson Z Ray
- Department of Neurological Surgery, Washington University, St. Louis, Missouri, USA
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Anderson KD, Bryden AM, Gran B, Hinze SW, Richmond MA. Definitions of recovery and reintegration across the first year: A qualitative study of perspectives of persons with spinal cord injury and caregivers. Spinal Cord 2024; 62:156-163. [PMID: 38351327 PMCID: PMC11003865 DOI: 10.1038/s41393-024-00962-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 04/11/2024]
Abstract
STUDY DESIGN Longitudinal, qualitative cohort study. OBJECTIVES To understand how people with newly acquired spinal cord injury (PWS) and their support person (SP) define recovery and successful community reintegration (CR) across the first 12 months post-injury (mpi) and their satisfaction with the rate of recovery and reintegration experienced. SETTING Academic and Veterans hospitals in Midwest USA. METHODS In-depth, semi-structured interviews were conducted in two cohorts of PWS and SP during the initial inpatient rehabilitation stay, at 6 mpi, and at 12 mpi. Recordings were transcribed; four authors independently undertook line-by-line coding. The team discussed codes to reach consensus and synthesize into broader themes within the International Classification of Function, Disability, and Health and Transformative frameworks. RESULTS Data are reported on 23 PWS and 21 SP. PWS and SP are similar in defining recovery as gaining motor function and achieving independence. However, SP more frequently define recovery in terms of maintaining positivity and emotional recovery. At 12 mpi both groups shift to define recovery according to progress. Social roles, being active, and employment are persistent themes of how PWS and SP define successful CR. However, SP also frequently define successful CR as reestablishing identity and emotional adjustment. Veterans with SCI less frequently defined successful CR as employment. CONCLUSIONS This study is the first to reveal how PWS and SP define recovery and reintegration during the first 12 mpi. Given decreasing lengths of stay, this information can be used to tailor rehabilitation strategies during the critical first year of injury to optimize recovery.
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Affiliation(s)
- Kim D Anderson
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
- MetroHealth Center for Rehabilitation Research, MetroHealth System, Cleveland, OH, USA.
| | - Anne M Bryden
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- MetroHealth Center for Rehabilitation Research, MetroHealth System, Cleveland, OH, USA
| | - Brian Gran
- Department of Sociology, Case Western Reserve University College of Arts and Sciences, Cleveland, OH, USA
| | - Susan W Hinze
- Department of Sociology, Case Western Reserve University College of Arts and Sciences, Cleveland, OH, USA
| | - Mary Ann Richmond
- Spinal Cord Injury/Disorders Center, Veteran Affairs Northeast Ohio Healthcare System, Cleveland, OH, USA
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Thomas AX, Erklauer JC. Neurocritical care and neuromonitoring considerations in acute pediatric spinal cord injury. Semin Pediatr Neurol 2024; 49:101122. [PMID: 38677801 DOI: 10.1016/j.spen.2024.101122] [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: 11/20/2023] [Revised: 02/26/2024] [Accepted: 03/18/2024] [Indexed: 04/29/2024]
Abstract
Management of pediatric spinal cord injury (SCI) is an essential skill for all pediatric neurocritical care physicians. In this review, we focus on the evaluation and management of pediatric SCI, highlight a novel framework for the monitoring of such patients in the intensive care unit (ICU), and introduce advancements in critical care techniques in monitoring and management. The initial evaluation and characterization of SCI is crucial for improving outcomes as well as prognostication. While physical examination and imaging are the main stays of the work-up, we propose the use of somatosensory evoked potentials (SSEPs) and transcranial magnetic stimulation (TMS) for challenging clinical scenarios. SSEPs allow for functional evaluation of the dorsal columns consisting of tracts associated with hand function, ambulation, and bladder function. Meanwhile, TMS has the potential for informing prognostication as well as response to rehabilitation. Spine stabilization, and in some cases surgical decompression, along with respiratory and hemodynamic management are essential. Emerging research suggests that targeted spinal cerebral perfusion pressure may provide potential benefits. This review aims to increase the pediatric neurocritical care physician's comfort with SCI while providing a novel algorithm for monitoring spinal cord function in the ICU.
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Affiliation(s)
- Ajay X Thomas
- Department of Pediatrics, Division of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine at Texas Children's Hospital, Houston, TX, USA.
| | - Jennifer C Erklauer
- Department of Pediatrics, Division of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine at Texas Children's Hospital, Houston, TX, USA; Department of Pediatrics, Division of Pediatric Critical Care Medicine, Baylor College of Medicine at Texas Children's Hospital, Houston, TX, USA
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Tamai K, Terai H, Nakamura H, Yokogawa N, Sasagawa T, Nakashima H, Segi N, Ito S, Funayama T, Eto F, Yamaji A, Watanabe K, Yamane J, Takeda K, Furuya T, Yunde A, Nakajima H, Yamada T, Hasegawa T, Terashima Y, Hirota R, Suzuki H, Imajo Y, Ikegami S, Uehara M, Tonomura H, Sakata M, Hashimoto K, Onoda Y, Kawaguchi K, Haruta Y, Suzuki N, Kato K, Uei H, Sawada H, Nakanishi K, Misaki K, Kuroda A, Inoue G, Kakutani K, Kakiuchi Y, Kiyasu K, Tominaga H, Tokumoto H, Iizuka Y, Takasawa E, Akeda K, Takegami N, Funao H, Oshima Y, Kaito T, Sakai D, Yoshii T, Ohba T, Otsuki B, Seki S, Miyazaki M, Ishihara M, Okada S, Imagama S, Kato S. Neurological recovery rate and predictive factors of incomplete AIS grade C spinal cord injury in the older aged population. Spinal Cord 2024; 62:149-155. [PMID: 38347110 DOI: 10.1038/s41393-024-00963-0] [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: 11/01/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 02/18/2024]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To define the prognosis and predictive factors for neurological improvement in older patients with incomplete spinal cord injury (SCI) of American Spinal Injury Association Impairment Scale grade C (AIS-C). SETTINGS Multi-institutions in Japan. METHODS We included patients aged ≥65 years with traumatic SCI of AIS-C who were treated conservatively or surgically with >3 follow-up months. To identify factors related to neurological improvement, patients were divided into three groups according to their neurological status at the final follow-up, with univariate among-group comparisons of demographics, radiographic, and therapeutic factors. Significant variables were included in the multivariate logistic regression analysis. RESULTS Overall, 296 older patients with SCI of AIS-C on admission were identified (average age: 75.2 years, average follow-up: 18.7 months). Among them, 190 (64.2%) patients improved to AIS-D and 21 (7.1%) patients improved to AIS-E at final follow-up. There were significant among-group differences in age (p = 0.026), body mass index (p = 0.007), status of pre-traumatic activities of daily living (ADL) (p = 0.037), and serum albumin concentrations (p = 0.011). Logistic regression analysis showed no significant differences in variables in the stratified group of patients who improved to AIS-D. Meanwhile, serum albumin was a significant variable in patients who improved to AIS-E (p = 0.026; OR: 6.20, pre-traumatic ADL was omitted due to data skewness). CONCLUSIONS Most older patients with incomplete AIS-C SCI demonstrated at least 1 grade of neurological improvement. However, <10% of patients achieved complete recovery. Key predictors of complete recovery were high serum albumin levels on admission and independent pre-traumatic ADL. SPONSORSHIP No funding was received for this study.
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Affiliation(s)
- Koji Tamai
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka-city, Osaka, 545-8585, Japan.
| | - Hidetomi Terai
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka-city, Osaka, 545-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka-city, Osaka, 545-8585, Japan
| | - Noriaki Yokogawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Takeshi Sasagawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
- Department of Orthopaedic Surgery, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae, Toyama, Toyama, 930-8550, Japan
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Naoki Segi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Sadayuki Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Toru Funayama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Fumihiko Eto
- Department of Orthopaedic Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Akihiro Yamaji
- Department of Orthopaedic Surgery, Ibaraki Seinan Medical Center Hospital, 2190, Sakaimachi, Sashima, Ibaraki, 306-0433, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Junichi Yamane
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Department of Orthopaedic Surgery, National Hospital Organization Murayama Medical Center, 2-37-1 Gakuen, Musashimurayama, Tokyo, 208-0011, Japan
| | - Kazuki Takeda
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, 8-2 Otemachi, Aoi-ku, Shizuoka, 420-0853, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Graduate school of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Atsushi Yunde
- Department of Orthopaedic Surgery, Graduate school of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Hideaki Nakajima
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Tomohiro Yamada
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
- Department of Orthopaedic Surgery, Nagoya Kyoritsu Hospital, 1-172 Hokke, Nakagawa-ku, Nagoya-shi, Aichi, 454-0933, Japan
| | - Tomohiko Hasegawa
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Yoshinori Terashima
- Department of Orthopaedic Surgery, Sapporo Medical University, South 1-West 16-291, Chuo-ku, Sapporo, 060-8543, Japan
- Department of Orthopaedic Surgery, Matsuda Orthopedic Memorial Hospital, North 18-East 4-1 Kita-ku, Sapporo, 001-0018, Japan
| | - Ryosuke Hirota
- Department of Orthopaedic Surgery, Sapporo Medical University, South 1-West 16-291, Chuo-ku, Sapporo, 060-8543, Japan
| | - Hidenori Suzuki
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube city, Yamaguchi, 755-8505, Japan
| | - Yasuaki Imajo
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube city, Yamaguchi, 755-8505, Japan
| | - Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Masashi Uehara
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hitoshi Tonomura
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Munehiro Sakata
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
- Department of Orthopaedics, Saiseikai Shiga Hospital, 2-4-1 Ohashi Ritto, Shiga, 520-3046, Japan
| | - Ko Hashimoto
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Yoshito Onoda
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Kenichi Kawaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yohei Haruta
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
| | - Nobuyuki Suzuki
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Kenji Kato
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Hiroshi Uei
- Department of Orthopaedic Surgery, Nihon University Hospital, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8393, Japan
- Department of Orthopaedic Surgery, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Hirokatsu Sawada
- Department of Orthopaedic Surgery, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Kazuo Nakanishi
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Kosuke Misaki
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Akiyoshi Kuroda
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Kenichiro Kakutani
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yuji Kakiuchi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Katsuhito Kiyasu
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, 783-8505, Japan
| | - Hiroyuki Tominaga
- Department of Orthopaedic Surgery, Graduate School of medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Hiroto Tokumoto
- Department of Orthopaedic Surgery, Graduate School of medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Yoichi Iizuka
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Eiji Takasawa
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Koji Akeda
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, 514-8507, Japan
| | - Norihiko Takegami
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, 514-8507, Japan
| | - Haruki Funao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 852 Hatakeda, Narita, Chiba, 286-0124, Japan
- Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-0124, Japan
- Department of Orthopaedic Surgery and Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takashi Kaito
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Daisuke Sakai
- Department of Orthopedics Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Tetsuro Ohba
- Department of Orthopaedic Surgery, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Bungo Otsuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaracho, Sakyo-ku, Kyoto, Kyoto, Japan
| | - Shoji Seki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Masashi Miyazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan
| | - Masayuki Ishihara
- Department of Orthopaedic Surgery, Kansai Medical University Hospital, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan
| | - Seiji Okada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Satoshi Kato
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
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11
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Bydon M, Qu W, Moinuddin FM, Hunt CL, Garlanger KL, Reeves RK, Windebank AJ, Zhao KD, Jarrah R, Trammell BC, El Sammak S, Michalopoulos GD, Katsos K, Graepel SP, Seidel-Miller KL, Beck LA, Laughlin RS, Dietz AB. Intrathecal delivery of adipose-derived mesenchymal stem cells in traumatic spinal cord injury: Phase I trial. Nat Commun 2024; 15:2201. [PMID: 38561341 PMCID: PMC10984970 DOI: 10.1038/s41467-024-46259-y] [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: 05/11/2023] [Accepted: 02/21/2024] [Indexed: 04/04/2024] Open
Abstract
Intrathecal delivery of autologous culture-expanded adipose tissue-derived mesenchymal stem cells (AD-MSC) could be utilized to treat traumatic spinal cord injury (SCI). This Phase I trial (ClinicalTrials.gov: NCT03308565) included 10 patients with American Spinal Injury Association Impairment Scale (AIS) grade A or B at the time of injury. The study's primary outcome was the safety profile, as captured by the nature and frequency of adverse events. Secondary outcomes included changes in sensory and motor scores, imaging, cerebrospinal fluid markers, and somatosensory evoked potentials. The manufacturing and delivery of the regimen were successful for all patients. The most commonly reported adverse events were headache and musculoskeletal pain, observed in 8 patients. No serious AEs were observed. At final follow-up, seven patients demonstrated improvement in AIS grade from the time of injection. In conclusion, the study met the primary endpoint, demonstrating that AD-MSC harvesting and administration were well-tolerated in patients with traumatic SCI.
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Affiliation(s)
- Mohamad Bydon
- Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA.
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Wenchun Qu
- Physical Medicine and Rehabilitation, Mayo Clinic, Jacksonville, FL, USA
| | - F M Moinuddin
- Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Ronald K Reeves
- Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | | | - Kristin D Zhao
- Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Ryan Jarrah
- Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Brandon C Trammell
- Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sally El Sammak
- Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Giorgos D Michalopoulos
- Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Konstantinos Katsos
- Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Lisa A Beck
- Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | | | - Allan B Dietz
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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12
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Scott MM, Patel DV, Lucasti C, Vallee EK, Clark LD, Kowalski JM. Hospital Course and Complications of Subaxial Cervical Trauma Patients With Tetraplegia or Paraplegia: A Case Series and Literature Review. Clin Spine Surg 2024; 37:E152-E157. [PMID: 38158604 DOI: 10.1097/bsd.0000000000001571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/06/2023] [Indexed: 01/03/2024]
Abstract
STUDY DESIGN A single-institution, retrospective cohort study. OBJECTIVE The objective was to present demographic characteristics, mechanism of injuries, lengths of stay, intensive care unit (ICU) days, discharge locations, and causes of 90-day readmission for patients with subaxial spinal cord injuries resulting in paraplegia or tetraplegia. SUMMARY OF BACKGROUND DATA Spinal cord injuries resulting in paraplegia or tetraplegia are rare injuries with debilitating outcomes. Numerous advances have occurred in caring for these patients, but patients still experience multiple complications. The severity of these injuries and numerous complications result in prolonged hospital stays and the need for extensive rehabilitation. METHODS Twelve patients with subaxial spinal cord injury resulting in paraplegia or tetraplegia from a level 1 adult trauma center were reviewed. The primary outcomes included hospital length of stay, ICU days, intrahospital complications, 90-day readmission rates, and discharge location. We reviewed the literature for these outcomes in spinal cord injuries. RESULTS For patients with subaxial spinal cord injuries resulting in paraplegia and tetraplegia, the average age was 36.0 years, and most were male [91.7% (11/12)]. The most common mechanism of injury was gunshot wounds[41.7% (5/12)]. Patients spent an average of 46.3 days in the hospital and 30.7 days in the ICU. Respiratory complications were the most common (9 patients). Fifty percent of patients (6/12) were discharged to the inpatient spinal cord rehab center, and 16.7% (2/12) expired while in the hospital. Two patients (20.0%) were readmitted within 90 days of discharge. CONCLUSIONS Most patients with subaxial spinal cord injuries resulting in paraplegia or tetraplegia were young males with high-energy traumas. Many patients had intrahospital complications, and most were discharged to the hospital spinal rehab center. These findings likely stem from the severity of paraplegia and tetraplegia injuries and the need for rehabilitation.
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Affiliation(s)
| | - Dil V Patel
- UBMD Orthopaedics and Sports Medicine Doctors, Buffalo, NY
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13
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Behnammoghadam M, Alimohammadi N, Riazi A, Eghbali-Babadi M, Rezvani M. Care needs of adults with spinal trauma in the prehospital and hospital setting from the perspective of patient care team: A qualitative research. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:83. [PMID: 38720688 PMCID: PMC11078458 DOI: 10.4103/jehp.jehp_282_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/26/2023] [Indexed: 05/12/2024]
Abstract
BACKGROUND Appropriate care of patients with definite spinal cord injury or at risk of it in the prehospital and hospital stages requires comprehensive planning in the health system. It is also the requirement of any successful program to explain the needs from the perspective of its stakeholders. Thus, this study aimed to discover the care needs of adults with spinal trauma in prehospital and hospital settings from the perspective of the patient care team. MATERIALS AND METHODS This qualitative study was conducted with the participation of urban and rural prehospital emergency personnel and emergency departments of educational and therapeutic hospitals affiliated to Isfahan, Tehran, Shiraz, Kermanshah, Ahvaz, and Yasuj Universities of Medical Sciences, through conducting 36 in-depth semi-structured interviews from September to December 2021. Using purposive sampling method, the participants were selected considering the maximum variation. The data saturation was reached after conducting interviews and group discussions with 36 subjects. Data were analyzed using conventional content analysis approach. Lundman and Graneheim approach were used for the study rigour. Data were simultaneously analyzed using MAXQDA software version 10. RESULT During the data analysis, two themes of prehospital care with two main categories (emergency care and management of secondary complications of spinal trauma) and hospital care with two main categories (emergency care and management of secondary complications of spinal trauma) emerged. CONCLUSION Emergency care and management of secondary complications of spinal cord injury in the prehospital and hospital stages can affect treatment results, improve quality of life, and reduce mortality rate, secondary injuries, and healthcare costs. Thus, identification of the care needs of the adults with spinal trauma from the perspective of the patient care team can help the authorities to plan appropriate interventions.
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Affiliation(s)
- Mohammad Behnammoghadam
- Department of Critical Care Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nasrollah Alimohammadi
- Department of Critical Care Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Riazi
- Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Eghbali-Babadi
- Department of Critical Care Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Rezvani
- Department of Neurosurgery, Neurosciences Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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14
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Zama D, Candela E, Pagano G, Venturelli F, Melchionda F, Toni F, Zucchelli M, Pession A. Pediatric non-Hodgkin lymphoma as a rare cause of spinal cord injury: When lymphoma hides in the canal. Clin Case Rep 2024; 12:e7789. [PMID: 38523827 PMCID: PMC10959824 DOI: 10.1002/ccr3.7789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/09/2023] [Accepted: 07/25/2023] [Indexed: 03/26/2024] Open
Abstract
Key Clinical Message Spinal cord compression from non-Hodgkin lymphoma (NHL) should be considered as a potential diagnosis in cases of acute signs of myelopathy in pediatric patients. Abstract Spinal cord compression in pediatric non-Hodgkin lymphoma (NHL) is a rare presentation with potential diagnostic challenges. We report on two pediatric patients with NHL who exhibited myelopathy signs as initial presentation. Considering NHL as a differential diagnosis in pediatric patients presenting with spinal cord compression is crucial for optimizing the outcome of these patients.
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Affiliation(s)
- Daniele Zama
- Pediatric Emergency UnitIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
- Department of Medical and Surgical Sciences, Alma Mater StudiorumUniversity of BolognaBolognaItaly
| | - Egidio Candela
- Department of Medical and Surgical Sciences, Alma Mater StudiorumUniversity of BolognaBolognaItaly
- Pediatric UnitIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Gennaro Pagano
- Specialty School of Paediatrics ‐ Alma Mater StudiorumUniversity of BolognaBolognaItaly
| | - Francesco Venturelli
- Department of Medical and Surgical Sciences, Alma Mater StudiorumUniversity of BolognaBolognaItaly
- Pediatric Oncology and Hematology Unit "Lalla Seràgnoli"IRCCS Azienda Ospedaliera‐Universitaria di BolognaBolognaItaly
| | - Fraia Melchionda
- Pediatric Oncology and Hematology Unit "Lalla Seràgnoli"IRCCS Azienda Ospedaliera‐Universitaria di BolognaBolognaItaly
| | - Francesco Toni
- Neuroradiology UnitIRCCS Istituto delle scienze Neurologiche di BolognaBolognaItaly
| | - Mino Zucchelli
- Pediatric Neurosurgery, Institute of Neurological ScienceIRCCS Bellaria HospitalBolognaItaly
| | - Andrea Pession
- Department of Medical and Surgical Sciences, Alma Mater StudiorumUniversity of BolognaBolognaItaly
- Pediatric UnitIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
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15
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Fehlings MG, Moghaddamjou A, Evaniew N, Tetreault LA, Alvi MA, Skelly AC, Kwon BK. The 2023 AO Spine-Praxis Guidelines in Acute Spinal Cord Injury: What Have We Learned? What Are the Critical Knowledge Gaps and Barriers to Implementation? Global Spine J 2024; 14:223S-230S. [PMID: 38526926 DOI: 10.1177/21925682231196825] [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: 03/27/2024] Open
Abstract
STUDY DESIGN Narrative summary of the 2023 AO Spine-Praxis clinical practice guidelines for management in acute spinal cord injury (SCI). OBJECTIVES The objective of this article is to summarize the key findings of the clinical practice guidelines for the optimal management of traumatic and intraoperative SCI (ISCI). This article will also highlight potential knowledge translation opportunities for each recommendation and discuss important knowledge gaps and areas of future research. METHODS Systematic reviews were conducted according to accepted methodological standards to evaluate the current body of evidence and inform the guideline development process. The summarized evidence was reviewed by a multidisciplinary guidelines development group that consisted of international multidisciplinary stakeholders. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to rate the certainty of the evidence for each critical outcome and the "evidence to recommendation" framework was used to formulate the final recommendations. RESULTS The key recommendations regarding the timing of surgical decompression, hemodynamic management, and the prevention, diagnosis, and management of ISCI are summarized. While a strong recommendation was made for early surgery, further prospective research is required to define what constitutes sufficient surgical decompression, examine the role of ultra-early surgery, and assess the impact of early surgery in different SCI phenotypes, including central cord syndrome. Furthermore, additional investigation is required to evaluate the impact of mean arterial blood pressure targets on neurological recovery and to determine the utility of spinal cord perfusion pressure measurements. Finally, there is a need to examine the role of neuroprotective agents for the treatment of ISCI and to prospectively validate the new AO Spine-Praxis care pathway for the prevention, diagnosis, and management of ISCI. To optimize the translation of these guidelines into practice, important barriers to their implementation, particularly in underserved areas, need to be explored. Ultimately, these recommendations will help to establish more personalized approaches to care for SCI patients. CONCLUSIONS The recommendations from the 2023 AO Spine-Praxis guidelines not only highlight the current best practice in the management of SCI, but reveal critical knowledge gaps and barriers to implementation that will help to guide further research efforts in SCI.
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Affiliation(s)
- Michael G Fehlings
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Ali Moghaddamjou
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Nathan Evaniew
- McCaig Institute for Bone and Joint Health, Department of Surgery, Orthopaedic Surgery, Cumming School of Medicine, University of Calgary, AB, Canada
| | | | - Mohammed Ali Alvi
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | | | - Brian K Kwon
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
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16
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Wang C, Chen M, Wang T, Wang Y, Zhu Y, Cui T, Hao Z, Wang D, He C. Prognostic value of the systemic inflammatory index (SII) and systemic inflammatory response index (SIRI) in patients with traumatic spinal cord injury. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1245-1255. [PMID: 38212411 DOI: 10.1007/s00586-023-08114-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/17/2023] [Accepted: 12/18/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE The overwhelming inflammatory response plays a critical role in the secondary injury cascade of traumatic spinal cord injury (tSCI). The systemic immune inflammatory index (SII) and systemic inflammatory response index (SIRI) are two novel inflammatory biomarkers. The SII was calculated based on lymphocyte, neutrophil, and platelet counts, while the SIRI was calculated based on lymphocyte, neutrophil, and monocyte counts. Their prognostic value in patients with tSCI remains unclear. METHODS Patients with tSCI admitted within 24 h of trauma were retrospectively and consecutively enrolled. Peripheral blood samples were collected on admission. The primary outcome was American Spinal Injury Association Impairment Scale (AIS) grade conversion at discharge. Multivariable logistic regression analysis was performed to determine the relationship between SII and SIRI and AIS grade conversion. We performed receiver operating characteristic curve (ROC) analysis to assess the discriminative ability of SII, and SIRI in predicting AIS grade conversion. RESULTS Among 280 included patients, 77 (27.5%) had improved AIS grade conversion at discharge. After adjustment for confounders, SII was independently associated with AIS grade conversion (per SD, odds ratio [OR], 0.68; 95% confidence interval [CI] 0.47-0.98, p = 0.040), while the association between SIRI and AIS grade conversion was insignificant (per 1 SD, OR, 0.77; 95% CI 0.55-1.08, p = 0.130). The ROC analysis revealed that the SII had the best predictive value for AIS grade conversion (area under curve: 0.608, 95% CI 0.536-0.678). CONCLUSIONS Increased SII was independently associated with a decreased likelihood of improved AIS grade conversion.
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Affiliation(s)
- Changyi Wang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, No.37 Guoxue Xiang, Chengdu, 610041, Sichuan, China
| | - Mingxi Chen
- Department of Neurology, West China Hospital, Sichuan University, No.37 Guoxue Xiang, Chengdu, 610041, Sichuan, China
| | - Tiantian Wang
- Department of Neurology, West China Hospital, Sichuan University, No.37 Guoxue Xiang, Chengdu, 610041, Sichuan, China
| | - Yihan Wang
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Yuyi Zhu
- Department of Neurology, West China Hospital, Sichuan University, No.37 Guoxue Xiang, Chengdu, 610041, Sichuan, China
| | - Ting Cui
- Department of Neurology, West China Hospital, Sichuan University, No.37 Guoxue Xiang, Chengdu, 610041, Sichuan, China
| | - Zilong Hao
- Department of Neurology, West China Hospital, Sichuan University, No.37 Guoxue Xiang, Chengdu, 610041, Sichuan, China.
| | - Deren Wang
- Department of Neurology, West China Hospital, Sichuan University, No.37 Guoxue Xiang, Chengdu, 610041, Sichuan, China.
| | - Chengqi He
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, No.37 Guoxue Xiang, Chengdu, 610041, Sichuan, China.
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17
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Arnold D, Gillespie J, Bennett M, Callender L, Sikka S, Hamilton R, Driver S, Swank C. Clinical Delivery of Overground Exoskeleton Gait Training in Persons With Spinal Cord Injury Across the Continuum of Care: A Retrospective Analysis. Top Spinal Cord Inj Rehabil 2024; 30:74-86. [PMID: 38433740 PMCID: PMC10906371 DOI: 10.46292/sci23-00001] [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] [Indexed: 03/05/2024]
Abstract
Background After spinal cord injury (SCI), inpatient rehabilitation begins and continues through outpatient therapy. Overground exoskeleton gait training (OEGT) has been shown to be feasible in both settings, yet its use as an intervention across the continuum has not yet been reported. Objectives This study describes OEGT for patients with SCI across the continuum and its effects on clinical outcomes. Methods Medical records of patients with SCI who completed at least one OEGT session during inpatient and outpatient rehabilitation from 2018 to 2021 were retrospectively reviewed. Demographic data, Walking Index for Spinal Cord Injury-II (WISCI-II) scores, and OEGT session details (frequency, "walk" time, "up" time, and step count) were extracted. Results Eighteen patients [male (83%), White (61%), aged 37.4 ± 15 years, with tetraplegia (50%), American Spinal Injury Association Impairment Scale A (28%), B (22%), C (39%), D (11%)] completed OEGT sessions (motor complete, 18.2 ± 10.3; motor incomplete, 16.7 ± 7.7) over approximately 18 weeks (motor complete, 15.1 ± 6.4; motor incomplete, 19.0 ± 8.2). Patients demonstrated improved OEGT session tolerance on device metrics including "walk" time (motor complete, 7:51 ± 4:42 to 24:50 ± 9:35 minutes; motor incomplete, 12:16 ± 6:01 to 20:01 ± 08:05 minutes), "up" time (motor complete, 16:03 ± 7:41 to 29:49 ± 12:44 minutes; motor incomplete, 16:38 ± 4:51 to 23:06 ± 08:50 minutes), and step count (motor complete, 340 ± 295.9 to 840.2 ± 379.4; motor incomplete, 372.3 ± 225.2 to 713.2 ± 272). Across therapy settings, patients with motor complete SCI experienced improvement in WISCI-II scores from 0 ± 0 at inpatient admission to 3 ± 4.6 by outpatient discharge, whereas the motor incomplete group demonstrated a change of 0.2 ± 0.4 to 9.0 ± 6.4. Conclusion Patients completed OEGT across the therapy continuum. Patients with motor incomplete SCI experienced clinically meaningful improvements in walking function.
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Affiliation(s)
- Dannae Arnold
- Baylor Scott and White Research Institute, Dallas, Texas
- Baylor Scott and White Institute for Rehabilitation, Dallas, Texas
| | - Jaime Gillespie
- Baylor Scott and White Research Institute, Dallas, Texas
- Baylor Scott and White Institute for Rehabilitation, Dallas, Texas
| | - Monica Bennett
- Baylor Scott and White Research Institute, Dallas, Texas
| | | | - Seema Sikka
- Baylor Scott and White Institute for Rehabilitation, Dallas, Texas
| | - Rita Hamilton
- Baylor Scott and White Institute for Rehabilitation, Dallas, Texas
| | - Simon Driver
- Baylor Scott and White Institute for Rehabilitation, Dallas, Texas
| | - Chad Swank
- Baylor Scott and White Research Institute, Dallas, Texas
- Baylor Scott and White Institute for Rehabilitation, Dallas, Texas
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18
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Wouda MF, Løtveit MF, Bengtson EI, Strøm V. The relationship between balance control and thigh muscle strength and muscle activity in persons with incomplete spinal cord injury. Spinal Cord Ser Cases 2024; 10:7. [PMID: 38418466 PMCID: PMC10902359 DOI: 10.1038/s41394-024-00620-x] [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: 09/28/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 03/01/2024] Open
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES A spinal cord injury (SCI) can compromise the ability to maintain sufficient balance control during activities in an upraised position. The objective of the study was to explore the relationship between balance control and muscle strength and muscle activation in the lower extremities in persons with incomplete SCI (iSCI). SETTING Sunnaas Rehabilitation Hospital, Norway. METHODS Thirteen men and two women with iSCI and 15 healthy, matched controls were included. Performance of the Berg Balance Scale (BBS) short version (7 items) was used to indicate balance control. Maximal voluntary contraction (MVC) was performed to measure isometric muscle strength in thigh muscles (knee extension/flexion), while surface electromyography (EMG) was measured from M. Vastus Lateralis and M. Biceps Femoris. The relative activation of each muscle during each of the BBS tasks was reported as the percentage of the maximal activation during the MVC (%EMGmax). RESULTS The iSCI participants had a significantly lower BBS sum score and up to 40% lower muscle strength in knee- flexion and extension compared to the matched healthy controls. They also exhibited a significantly higher %EMGmax, i.e. a higher muscle activation, during most of the balance tests. Univariate regression analysis revealed a significant association between balance control and mean values of %EMGmax in Biceps Femoris, averaged over the seven BBS tests. CONCLUSIONS The participants with iSCI had poorer balance control, reduced thigh muscle strength and a higher relative muscle activation in their thigh muscles, during balance-demanding activities.
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Affiliation(s)
- Matthijs Ferdinand Wouda
- Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway.
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway.
| | - Marte Fosvold Løtveit
- Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | | | - Vegard Strøm
- Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
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19
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Saita K, Sumitani M, Koyama Y, Sugita S, Matsubayashi Y, Ogata T, Ohtsu H, Chikuda H. Neuropathic pain development and maintenance and its association with motor recovery after cervical spinal cord injury. J Spinal Cord Med 2024:1-8. [PMID: 38391257 DOI: 10.1080/10790268.2024.2309421] [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: 02/24/2024] Open
Abstract
BACKGROUND In our published randomized controlled trial, we revealed that patients with acute ASIA Grade C incomplete cervical spinal cord injury (SCI) who underwent early surgery (within 24 h post-injury) had accelerated motor recovery at six months than those with delayed surgery (>2 weeks post-injury); however, neuropathic pain (NeP) worsened regardless of surgery timing. Here, we conducted post-hoc analyses to intensively assess NeP development and maintenance. METHODS Of 44 patients (median 64.5 years; three female; early intervention, n = 26), NeP was categorized into at-level and below-level pain and evaluated at two weeks and one year after injury using the Neuropathic Pain Symptom Inventory (NPSI). We compared the two groups based on background characteristics. A mixed-design analysis of variance with sex as a covariate was conducted to analyze motor recovery and Health-related quality of life (HRQOL) in groups with severe (NPSI ≥ 10) or mild (NPSI < 10) pain. RESULTS Upper and lower limb motor impairments were comparable between both groups regardless of pain severity. Severe at-level pain remained stable and worsened at one year than mild at-level pain; however, the upper- and lower-limb motor scores and HRQOL had comparable recovery. Background characteristics did not affect severity or time course of NeP. Patients with severe below-level pain demonstrated slower lower-limb motor recovery than those with mild below-level pain, whereas HRQOL improved regardless of pain severity. CONCLUSIONS Both at-level and below-level NeP developed and persisted relatively early in the course of traumatic SCI with incomplete motor paralysis; their severities worsened over time or remained severe since onset.
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Affiliation(s)
- Kosuke Saita
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Masahiko Sumitani
- Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Yurie Koyama
- School of Nursing, Kitasato University, Kanagawa, Japan
| | - Shurei Sugita
- Department of Orthopaedic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | | | - Toru Ogata
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiroshi Ohtsu
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University, Gunma, Japan
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20
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Mputu Mputu P, Beauséjour M, Richard-Denis A, Fallah N, Noonan VK, Mac-Thiong JM. Classifying clinical phenotypes of functional recovery for acute traumatic spinal cord injury. An observational cohort study. Disabil Rehabil 2024:1-8. [PMID: 38390856 DOI: 10.1080/09638288.2024.2320267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 02/14/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE Identify patient subgroups with different functional outcomes after SCI and study the association between functional status and initial ISNCSCI components. METHODS Using CART, we performed an observational cohort study on data from 675 patients enrolled in the Rick-Hansen Registry(RHSCIR) between 2014 and 2019. The outcome was the Spinal Cord Independence Measure (SCIM) and predictors included AIS, NLI, UEMS, LEMS, pinprick(PPSS), and light touch(LTSS) scores. A temporal validation was performed on data from 62 patients treated between 2020 and 2021 in one of the RHSCIR participating centers. RESULTS The final CART resulted in four subgroups with increasing totSCIM according to PPSS, LEMS, and UEMS: 1)PPSS < 27(totSCIM = 28.4 ± 16.3); 2)PPSS ≥ 27, LEMS < 1.5, UEMS < 45(totSCIM = 39.5 ± 19.0); 3)PPSS ≥ 27, LEMS < 1.5, UEMS ≥ 45(totSCIM = 57.4 ± 13.8); 4)PPSS ≥ 27, LEMS ≥ 1.5(totSCIM = 66.3 ± 21.7). The validation model performed similarly to the original model. The adjusted R-squared and F-test were respectively 0.556 and 62.2(P-value <0.001) in the development cohort and, 0.520 and 31.9(P-value <0.001) in the validation cohort. CONCLUSION Acknowledging the presence of four characteristic subgroups of patients with distinct phenotypes of functional recovery based on PPSS, LEMS, and UEMS could be used by clinicians early after tSCI to plan rehabilitation and establish realistic goals. An improved sensory function could be key for potentiating motor gains, as a PPSS ≥ 27 was a predictor of a good function.
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Affiliation(s)
- Pascal Mputu Mputu
- Hôpital du Sacré-Cœur de Montréal/CIUSSS NÎM, Montreal, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Marie Beauséjour
- Department of Community Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
- CHU Sainte-Justine, Montreal, Canada
| | - Andréane Richard-Denis
- Hôpital du Sacré-Cœur de Montréal/CIUSSS NÎM, Montreal, Canada
- Centre de recherche interdisciplinaire en réadaptation (CRIR), Montreal, Canada
| | - Nader Fallah
- Praxis Spinal Cord Institute, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Vanessa K Noonan
- Praxis Spinal Cord Institute, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Jean-Marc Mac-Thiong
- Hôpital du Sacré-Cœur de Montréal/CIUSSS NÎM, Montreal, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Canada
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21
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Jeffery ND, Rossmeisl JH, Harcourt-Brown TR, Granger N, Ito D, Foss K, Chase D. Randomized Controlled Trial of Durotomy as an Adjunct to Routine Decompressive Surgery for Dogs With Severe Acute Spinal Cord Injury. Neurotrauma Rep 2024; 5:128-138. [PMID: 38414780 PMCID: PMC10898236 DOI: 10.1089/neur.2023.0129] [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: 02/29/2024] Open
Abstract
Although many interventions for acute spinal cord injury (SCI) appear promising in experimental models, translation directly from experimental animals to human patients is a large step that can be problematic. Acute SCI occurs frequently in companion dogs and may provide a model to ease translation. Recently, incision of the dura has been highlighted in both research animals and human patients as a means of reducing intraspinal pressure, with a view to improving perfusion of the injured tissue and enhancing functional recovery. Observational clinical data in humans and dogs support the notion that it may also improve functional outcome. Here, we report the results of a multi-center randomized controlled trial of durotomy as an adjunct to traditional decompressive surgery for treatment of severe thoracolumbar SCI caused by acute intervertebral disc herniation in dogs. Sample-size calculation was based on the proportion of dogs recovering ambulation improving from an expected 55% in the traditional surgery group to 70% in the durotomy group. Over a 3.5-year period, we enrolled 140 dogs, of which 128 had appropriate duration of follow-up. Overall, 65 (51%) dogs recovered ambulation. Recovery in the traditional decompression group was 35 of 62 (56%) dogs, and in the durotomy group 30 of 66 (45%) dogs, associated with an odds ratio of 0.643 (95% confidence interval: 0.320-1.292) and z-score of -1.24. This z-score indicates trial futility to reach the target 15% improvement over traditional surgery, and the trial was terminated at this stage. We conclude that durotomy is ineffective in improving functional outcome for severe acute thoracolumbar SCI in dogs. In the future, these data can be compared with similar data from clinical trials on duraplasty in human patients and will aid in determining the predictive validity of the "companion dog model" of acute SCI.
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Affiliation(s)
- Nick D. Jeffery
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas, USA
| | - John H. Rossmeisl
- Department of Small Animal Clinical Sciences, VA-MD College of Veterinary Medicine, Blacksburg, Virginia, USA
| | | | | | - Daisuke Ito
- Nihon University College of Bioresource Sciences Department of Veterinary Medicine, Fujisawa, Japan
| | - Kari Foss
- Department of Veterinary Clinical Medicine, University of Illinois Urbana–Champaign, Champaign, Illinois, USA
| | - Damian Chase
- Veterinary Specialists Aotearora, Auckland, New Zealand
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22
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Schuld C, Kirshblum S, Tansey K, Rupp R. The revised zone of partial preservation (ZPP) in the 2019 International Standards for Neurological Classification of Spinal Cord Injury: ZPP applicability in incomplete injuries. Spinal Cord 2024; 62:79-87. [PMID: 38191920 PMCID: PMC10853064 DOI: 10.1038/s41393-023-00950-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 11/17/2023] [Accepted: 12/13/2023] [Indexed: 01/10/2024]
Abstract
STUDY DESIGN Consensus process. OBJECTIVES To provide a reference for the Zone(s) of Partial Preservation (ZPP) in the 2019 International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and analyze the initial impact of applicability of the revised ZPPs. Revisions include the use of ZPPs in selected incomplete injuries (in addition to prior use in sensorimotor complete injuries). Specifically, the revised motor ZPPs are applicable bilaterally in injuries with absent voluntary anal contraction (VAC) and the revised sensory ZPP for a given side is applicable if deep anal pressure (DAP), light touch and pin prick sensation in S4-5 are absent on that side. SETTING Committee with 16 ISNCSCI experts and datasets from the European Multicenter Study about Spinal Cord Injury (EMSCI). METHODS Occurrence frequencies of applicable ZPPs were determined in an EMSCI cohort consisting of two ISNCSCI examinations from 665 individuals with traumatic SCI. RESULTS Motor ZPPs were derived in 35.2% of all datasets of incomplete injuries, while sensory ZPPs are much less frequent (1.0%). Motor ZPPs are applicable in all American Spinal Injury Association Impairment Scale (AIS) B datasets (mean ZPP length: 0.9 ± 1.0 segments), in 55.4% of all AIS C datasets (ZPP length: 11.8 ± 8.2 segments) and in 9.9% of the AIS D datasets (ZPP length: 15.4 ± 7.9 segments). CONCLUSIONS The revised ZPP allows for determining motor ZPPs in approximately 1/3 of all incomplete injuries. The broadened applicability enables the use of ZPPs beyond complete injuries for complementary description of residual functions in more individuals. SPONSORSHIP N/A.
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Affiliation(s)
- Christian Schuld
- Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany
| | - Steven Kirshblum
- Kessler Institute for Rehabilitation, West Orange, NJ, USA
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Keith Tansey
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, MS, USA
- Spinal Cord Injury Clinic, Jackson VA Medical Center, Jackson, MS, USA
- Departments of Neurosurgery and Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, MS, USA
| | - Rüdiger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany.
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23
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Chiu AK, Bustos SP, Hasan O, Henry LE, Oster BA, Ratanpal AS, Padovano R, Brush PL, Pease TJ, Smith RA, Jauregui JJ, Bivona LJ, Cavanaugh DL, Koh EY, Vaccaro AR, Ludwig SC. Lower Extremity Somatosensory Evoked Potentials Predict Functional Outcomes in Complete Traumatic Cervical Spinal Cord Injury. World Neurosurg 2024; 182:e301-e307. [PMID: 38008173 DOI: 10.1016/j.wneu.2023.11.104] [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: 09/11/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Traumatic cervical spinal cord injury (tCSCI) is often a debilitating injury, making early prognosis important for medical and surgical planning. Currently, the best early predictors of prognosis are physical examination, imaging studies, and patient demographics. Despite these factors, patient outcomes continue to vary significantly. The purpose of this study was to evaluate the prognostic value of somatosensory evoked potentials (SSEPs) with functional outcomes in tCSCI patients. METHODS A retrospective study was conducted on prospectively collected data from 2 academic institutions. Patients 18 years and older who had tCSCI and underwent posterior cervical decompression and stabilization with intraoperative neuromonitoring were reviewed. The outcomes of interest were the American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade and ASIA motor score at follow-up. Outcomes measures were assessed via student t-tests, chi-squared tests, and multivariable regression analysis. RESULTS A total of 79 patients were included. In complete injuries, detectable lower extremity SSEPs were associated with higher ASIA motor scores at follow-up (P = 0.002), greater increases in ASIA motor scores at follow-up (P = 0.009), and a greater likelihood of clinically important improvement in ASIA motor score (P = 0.024). Incomplete, AIS grade C injuries has higher rates of grade conversion (P = 0.019) and clinically important improvement in ASIA motor score (P = 0.010), compared to AIS grade A or B injuries. CONCLUSIONS The detection of lower extremity SSEP signals during initial surgical treatment of tCSCI is associated with greater improvement in ASIA motor scores postoperatively. The association is most applicable to patients with complete injury.
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Affiliation(s)
- Anthony K Chiu
- Division of Spine Surgery, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sabrina P Bustos
- Liberty University College of Osteopathic Medicine, Lynchburg, Virginia, USA
| | - Ovais Hasan
- Division of Spine Surgery, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Leah E Henry
- Division of Spine Surgery, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Brittany A Oster
- Division of Spine Surgery, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Amit S Ratanpal
- Division of Spine Surgery, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Richard Padovano
- Departments of Orthopaedic Surgery and Neurological Surgery, Thomas Jefferson University and The Rothman Institute, Philadelphia, Pennsylvania, USA
| | - Parker L Brush
- Departments of Orthopaedic Surgery and Neurological Surgery, Thomas Jefferson University and The Rothman Institute, Philadelphia, Pennsylvania, USA
| | - Tyler J Pease
- Division of Spine Surgery, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ryan A Smith
- Division of Spine Surgery, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Julio J Jauregui
- Division of Spine Surgery, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Louis J Bivona
- Division of Spine Surgery, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Daniel L Cavanaugh
- Division of Spine Surgery, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Eugene Y Koh
- Division of Spine Surgery, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Alexander R Vaccaro
- Departments of Orthopaedic Surgery and Neurological Surgery, Thomas Jefferson University and The Rothman Institute, Philadelphia, Pennsylvania, USA
| | - Steven C Ludwig
- Division of Spine Surgery, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA.
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24
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Alavinia M, Farahani F, Musselman K, Plourde K, Omidvar M, Verrier MC, Aliabadi S, Craven BC. Convergent validity and responsiveness of The Standing and Walking Assessment Tool (SWAT) among individuals with non-traumatic spinal cord injury. Front Neurol 2024; 14:1280225. [PMID: 38322795 PMCID: PMC10844483 DOI: 10.3389/fneur.2023.1280225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/28/2023] [Indexed: 02/08/2024] Open
Abstract
Aim This study aimed to (1) describe the use of the Standing and Walking Assessment Tool (SWAT) among individuals with non-traumatic spinal cord injury or disease (NT-SCI/D); (2) evaluate the convergent validity of SWAT for use among inpatients with NT-SCI/D; (3) describe SWAT responsiveness; and (4) explore the relationship between hours of walking therapy and SWAT change. Methods A quality improvement project was conducted at the University Health Network between 2019 and 2022. Participants' demographics and impairments data, rehabilitation length of stay, and FIM scores were obtained from the National Rehabilitation Reporting System. The walking measure data were collected by therapists as part of routine practice. Hours of part- or whole-gait practice were abstracted from medical records. To determine convergent validity, Spearman's correlation coefficients were calculated between SWAT stages (admission and discharge) and the walking measures. The change in SWAT levels was calculated to determine responsiveness. Spearman's correlation coefficient was calculated between SWAT change and hours of walking therapy. Results Among adult NT-SCI/D participants with potential walking capacity (SWAT≥1B), the majority were classified as American Spinal Injury Association (ASIA) Impairment Scale D (AIS D) at admission. The SWAT category of 1C (N = 100, 18%) was the most frequent at admission. The most frequent SWAT stage at discharge was 3C among participants with NT-SCI/D, with positive conversions in SWAT stages from admission to discharge (N = 276, 33%). The mean change in SWAT score was 3 for participants with T-SCI and NT-SCI/D. Moderate correlations between SWAT stages and walking measures were observed. The correlation of hours of gait therapy with the SWAT change (admission to discharge) was 0.44 (p < 0001). Conclusion The SWAT has sufficient convergent validity and responsiveness for describing standing and walking recovery and communicating/monitoring rehabilitation progress among patients with NT-SCI/D.
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Affiliation(s)
- Mohammad Alavinia
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Farnoosh Farahani
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Kristin Musselman
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kristina Plourde
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Maryam Omidvar
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Molly C. Verrier
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Saina Aliabadi
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- School of Graduate Studies, University of Toronto, Toronto, ON, Canada
| | - B. Catharine Craven
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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25
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Fisher KM, Garner JP, Darian-Smith C. Chronic Adaptations in the Dorsal Horn Following a Cervical Spinal Cord Injury in Primates. J Neurosci 2024; 44:e0877232023. [PMID: 38233220 PMCID: PMC10860610 DOI: 10.1523/jneurosci.0877-23.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 11/21/2023] [Accepted: 12/01/2023] [Indexed: 01/19/2024] Open
Abstract
Spinal cord injury (SCI) is devastating, with limited treatment options and variable outcomes. Most in vivo SCI research has focused on the acute and early post-injury periods, and the promotion of axonal growth, so little is understood about the clinically stable chronic state, axonal growth over time, and what plasticity endures. Here, we followed animals into the chronic phase following SCI, to address this gap. Male macaques received targeted deafferentation, affecting three digits of one hand, and were divided into short (4-6 months) or long-term (11-12 months) groups, based on post-injury survival times. Monkeys were assessed behaviorally, where possible, and all exhibited an initial post-injury deficit in manual dexterity, with gradual functional recovery over 2 months. We previously reported extensive sprouting of somatosensory corticospinal (S1 CST) fibers in the dorsal horn in the first five post-injury months. Here, we show that by 1 year, the S1 CST sprouting is pruned, with the terminal territory resembling control animals. This was reflected in the number of putatively "functional" synapses observed, which increased over the first 4-5 months, and then returned to baseline by 1 year. Microglia density also increased in the affected dorsal horn at 4-6 months and then decreased, but did not return to baseline by 1 year, suggesting refinement continues beyond this time. Overall, there is a long period of reorganization and consolidation of adaptive circuitry in the dorsal horn, extending well beyond the initial behavioral recovery. This provides a potential window to target therapeutic opportunities during the chronic phase.
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Affiliation(s)
- Karen M Fisher
- Department of Comparative Medicine, Stanford University School of Medicine, Stanford 94305-5342, California
| | - Joseph P Garner
- Department of Comparative Medicine, Stanford University School of Medicine, Stanford 94305-5342, California
| | - Corinna Darian-Smith
- Department of Comparative Medicine, Stanford University School of Medicine, Stanford 94305-5342, California
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Wasiak K, Frasuńska J, Tarnacka B. Can the Initial Parameters of Functional Scales Predict Recovery in Patients with Complete Spinal Cord Injury? A Retrospective Cohort Study. Diagnostics (Basel) 2024; 14:129. [PMID: 38248006 PMCID: PMC10814489 DOI: 10.3390/diagnostics14020129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/31/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
Regaining greater independence in performing daily activities constitutes a priority for people with tetraplegia following spinal cord injury (SCI). The highest expectations are connected with the improvement of hand function. Therefore, it is so important for the clinician to identify reliable and commonly applicable prognostic factors for functional improvement. The aim of this study was to conduct an analysis to assess the impact of initial functional factors on the clinical improvement in patients during early neurological rehabilitation (ENR). This study assessed 38 patients with complete SCI aged 17-78 who underwent ENR in 2012-2022. The analysis included the motor score from the AIS (MS), the Barthel Index (BI) and the SCIM scale values at the beginning of the ENR program and after its completion. During ENR, patients achieved a statistically significant improvement in MS, BI and SCIM. The initial MS and the level of neurological injury constituted the predictors of functional improvement during ENR. Significant statistical relationships were observed primarily in the correlations between the initial MS and BI, and the increase in the analyzed functional scales of SCI patients. Higher initial MS may increase the chances of a greater and faster functional improvement during ENR.
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Affiliation(s)
- Krzysztof Wasiak
- Department of Rehabilitation, Mazovian Rehabilitation Center STOCER, 05-520 Konstancin-Jeziorna, Poland;
| | - Justyna Frasuńska
- Department of Rehabilitation, Medical University of Warsaw, 02-637 Warsaw, Poland;
| | - Beata Tarnacka
- Department of Rehabilitation, Medical University of Warsaw, 02-637 Warsaw, Poland;
- Department of Rehabilitation, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
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Fallah N, Noonan VK, Waheed Z, Charest-Morin R, Dandurand C, Cheng C, Ailon T, Dea N, Paquette S, Street JT, Fisher C, Dvorak MF, Kwon BK. Pattern of neurological recovery in persons with an acute cervical spinal cord injury over the first 14 days post injury. Front Neurol 2023; 14:1278826. [PMID: 38169683 PMCID: PMC10758406 DOI: 10.3389/fneur.2023.1278826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/31/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction Following a traumatic spinal cord injury (SCI) it is critical to document the level and severity of injury. Neurological recovery occurs dynamically after injury and a baseline neurological exam offers a snapshot of the patient's impairment at that time. Understanding when this exam occurs in the recovery process is crucial for discussing prognosis and acute clinical trial enrollment. The objectives of this study were to: (1) describe the trajectory of motor recovery in persons with acute cervical SCI in the first 14 days post-injury; and (2) evaluate if the timing of the baseline neurological assessment in the first 14 days impacts the amount of motor recovery observed. Methods Data were obtained from the Rick Hansen Spinal Cord Injury Registry (RHSCIR) site in Vancouver and additional neurological data was extracted from medical charts. Participants with a cervical injury (C1-T1) who had a minimum of three exams (including a baseline and discharge exam) were included. Data on the upper-extremity motor score (UEMS), total motor score (TMS) and American Spinal Injury Association (ASIA) Impairment Scale (AIS) were included. A linear mixed-effect model with additional variables (AIS, level of injury, UEMS, time, time2, and TMS) was used to explore the pattern and amount of motor recovery over time. Results Trajectories of motor recovery in the first 14 days post-injury showed significant improvements in both TMS and UEMS for participants with AIS B, C, and D injuries, but was not different for high (C1-4) vs. low (C5-T1) cervical injuries or AIS A injuries. The timing of the baseline neurological examination significantly impacted the amount of motor recovery in participants with AIS B, C, and D injuries. Discussion Timing of baseline neurological exams was significantly associated with the amount of motor recovery in cervical AIS B, C, and D injuries. Studies examining changes in neurological recovery should consider stratifying by severity and timing of the baseline exam to reduce bias amongst study cohorts. Future studies should validate these estimates for cervical AIS B, C, and D injuries to see if they can serve as an "adjustment factor" to control for differences in the timing of the baseline neurological exam.
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Affiliation(s)
- Nader Fallah
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Zeina Waheed
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
| | - Raphaele Charest-Morin
- Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia, Vancouver, BC, Canada
| | - Charlotte Dandurand
- Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia, Vancouver, BC, Canada
| | | | - Tamir Ailon
- Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia, Vancouver, BC, Canada
| | - Nicolas Dea
- Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia, Vancouver, BC, Canada
| | - Scott Paquette
- Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia, Vancouver, BC, Canada
| | - John T. Street
- Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia, Vancouver, BC, Canada
| | - Charles Fisher
- Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia, Vancouver, BC, Canada
| | - Marcel F. Dvorak
- Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Brian K. Kwon
- Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
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Bhimani AD, Carr MT, Al-sharshai Z, Hickman Z, Margetis K. Ultra-early (≤8 hours) surgery for thoracolumbar spinal cord injuries: A systematic review and meta-analysis. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100285. [PMID: 37942310 PMCID: PMC10628804 DOI: 10.1016/j.xnsj.2023.100285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/29/2023] [Accepted: 10/01/2023] [Indexed: 11/10/2023]
Abstract
Background The impact of the timing of surgery on neurological recovery in thoracolumbar spinal cord injuries (tSCI) is still a subject of discussion. Accumulating evidence is supporting early decompression (<24 hours) following tSCI. However, the potential advantages of earlier decompression remain uncertain. This systematic review and meta-analysis summarize and analyze the current evidence on the effectiveness of ultra-early decompression surgery on clinical outcomes following tSCI. Methods A search was conducted in the electronic databases Medline, Embase, Scopus, and Web of Science from their inception until May 2022 for human studies. Groups were stratified into ultra-early (surgery within 8 hours of injury) vs control group operated >8 hours of injury. The authors included the study data from their institutional case series of thoracolumbar spinal cord injury from 2015 to 2018. An arm-based meta-analysis was performed on all studies using the R Studio. For studies that qualified, a contrast-based meta-analysis was also performed with a standardized mean difference (SMD). Outcomes were reported as effect size, treatment effect, and effect difference, all with 95% confidence intervals (CI). Results Of the 133 patients, 74.4% patients were male. 76 (57.1%) underwent decompression ≤8 hours, while 57 (42.9%) underwent decompression >8 hours from injury. Quantitative analysis using the SMD model showed a significant difference in mean AIS improvement in the ultra-early group (Effect size 1.15 [0.62-1.67], p<.0001). On arm-based meta-analysis, a statistically significant treatment effect was found for the ultra-early arm (1.25 [0.91-1.67]), while > 8-hour arm did not show significance (0.30 [-0.08-0.71]). There was a statistically significant effect difference between the two arms (0.96 [0.49-1.48]). Conclusions This study observed a significant improvement in the mean AIS score in patients undergoing decompression within 8 hours of tSCI. Given the scant literature regarding ultra-early decompression of tSCI, this study solidifies the need to further explore the role of early interventions for tSCIs to improve patient outcomes.
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Affiliation(s)
- Abhiraj D. Bhimani
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1136, New York, NY 10029, United States
| | - Matthew T. Carr
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1136, New York, NY 10029, United States
| | - Zahraa Al-sharshai
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1136, New York, NY 10029, United States
| | - Zachary Hickman
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1136, New York, NY 10029, United States
| | - Konstantinos Margetis
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1136, New York, NY 10029, United States
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Li K, Liu Z, Wu P, Chen S, Wang M, Liu W, Zhang L, Guo S, Liu Y, Liu P, Zhang B, Tao L, Ding H, Qian H, Fu Q. Micro electrical fields induced MSC-sEVs attenuate neuronal cell apoptosis by activating autophagy via lncRNA MALAT1/miR-22-3p/SIRT1/AMPK axis in spinal cord injury. J Nanobiotechnology 2023; 21:451. [PMID: 38012570 PMCID: PMC10680254 DOI: 10.1186/s12951-023-02217-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/17/2023] [Indexed: 11/29/2023] Open
Abstract
Spinal cord injury (SCI) is a traumatic condition of the central nervous system that causes paralysis of the limbs. Micro electric fields (EF) have been implicated in a novel therapeutic approach for nerve injury repair and regeneration, but the effects of human umbilical cord mesenchymal stem cell-derived small extracellular vesicles that are induced by micro electric fields (EF-sEVs) stimulation on SCI remain unknown. The aim of the present study was to investigate whether EF-sEVs have therapeutic effects a rat model of SCI. EF-sEVs and normally conditioned human umbilical cord mesenchymal stem cells-derived small extracellular vesicles (CON-sEVs) were collected and injected intralesionally into SCI model rats to evaluate the therapeutic effects. We detect the expression of candidate long noncoding RNA metastasis-associated lung adenocarcinoma transcript 1 (lncRNA-MALAT1) in EF-sEVs and CON-sEVs. The targets and downstream effectors of lncRNA-MALAT1 were investigated using luciferase reporter assays. Using both in vivo and in vitro experiments, we demonstrated that EF-sEVs increased autophagy and decreased apoptosis after SCI, which promoted the recovery of motor function. We further confirmed that the neuroprotective effects of EF-sEVs in vitro and in vivo correlated with the presence of encapsulated lncRNA-MALAT1 in sEVs. lncRNA-MALAT1 targeted miR-22-3p via sponging, reducing miR-22-3p's suppressive effects on its target, SIRT1, and this translated into AMPK phosphorylation and increased levels of the antiapoptotic protein Bcl-2. Collectively, the present study identified that the lncRNA-MALAT1 in EF-sEVs plays a neuroprotective role via the miRNA-22-3p/SIRT1/AMPK axis and offers a fresh perspective and a potential therapeutic approach using sEVs to improve SCI.
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Affiliation(s)
- Kewei Li
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Zhong Liu
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Peipei Wu
- Key Laboratory of Laboratory Medicine of Jiangsu Province, School of Medicine, Jiangsu University, Zhenjiang, 212013, Jiangsu, China
- Department of Laboratory Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Shenyuan Chen
- Key Laboratory of Laboratory Medicine of Jiangsu Province, School of Medicine, Jiangsu University, Zhenjiang, 212013, Jiangsu, China
| | - Min Wang
- Key Laboratory of Laboratory Medicine of Jiangsu Province, School of Medicine, Jiangsu University, Zhenjiang, 212013, Jiangsu, China
| | - Wenhui Liu
- Key Laboratory of Laboratory Medicine of Jiangsu Province, School of Medicine, Jiangsu University, Zhenjiang, 212013, Jiangsu, China
| | - Leilei Zhang
- Key Laboratory of Laboratory Medicine of Jiangsu Province, School of Medicine, Jiangsu University, Zhenjiang, 212013, Jiangsu, China
| | - Song Guo
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Yanbin Liu
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Pengcheng Liu
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Beiting Zhang
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Lin Tao
- Department of Orthopaedics, Dehong Hospital of Traditional Chinese Medicine, Dehong, 678400, Yunnan, China
| | - Hua Ding
- Department of Orthopaedics, Affiliated People's Hospital of Jiangsu University, Zhenjiang, 212002, Jiangsu, China.
| | - Hui Qian
- Key Laboratory of Laboratory Medicine of Jiangsu Province, School of Medicine, Jiangsu University, Zhenjiang, 212013, Jiangsu, China.
| | - Qiang Fu
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China.
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Stewart AN, Gensel JC, Jones L, Fouad K. Challenges in Translating Regenerative Therapies for Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2023; 29:23-43. [PMID: 38174141 PMCID: PMC10759906 DOI: 10.46292/sci23-00044s] [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] [Indexed: 01/05/2024]
Abstract
Regenerating the injured spinal cord is a substantial challenge with many obstacles that need to be overcome to achieve robust functional benefits. This abundance of hurdles can partly explain the limited success when applying regenerative intervention treatments in animal models and/or people. In this article, we elaborate on a few of these obstacles, starting with the applicability of animal models and how they compare to the clinical setting. We then discuss the requirement for combinatorial interventions and the associated problems in experimental design, including the addition of rehabilitative training. The article expands on differences in lesion sizes and locations between humans and common animal models, and how this difference can determine the success or failure of an intervention. An additional and frequently overlooked problem in the translation of interventions that applies beyond the field of neuroregeneration is the reporting bias and the lack of transparency in reporting findings. New data mandates are tackling this problem and will eventually result in a more balanced view of the field. Finally, we will discuss strategies to negotiate the challenging course of successful translation to facilitate successful translation of regeneration promoting interventions.
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Affiliation(s)
- Andrew N. Stewart
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, Kentucky, USA
| | - John C. Gensel
- Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, Kentucky, USA
| | - Linda Jones
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Karim Fouad
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
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Yoshikawa K, Mutsuzaki H, Koseki K, Iwai K, Takeuchi R, Kohno Y. Gait training using a wearable robotic hip device for incomplete spinal cord injury: A preliminary study. J Spinal Cord Med 2023:1-13. [PMID: 37934493 DOI: 10.1080/10790268.2023.2273587] [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: 11/08/2023] Open
Abstract
CONTEXT/OBJECTIVE To explore changes in gait functions for patients with chronic spinal cord injury (SCI) before and after standard rehabilitation and rehabilitation with a wearable hip device, explore the utility of robot-assisted gait training (RAGT), and evaluate the safety and dose of RAGT. DESIGN Single-arm, open-label, observational study. SETTING A rehabilitation hospital. PARTICIPANTS Twelve patients with SCI. INTERVENTIONS Standard rehabilitation after admission in the first phase. RAGT for two weeks in the second phase. OUTCOME MEASURES Self-selected walking speed (SWS), step length, cadence, and the 6-minute walking distance were the primary outcomes. Walking Index for SCI score, lower extremity motor score, and spasticity were measured. Walking abilities were compared between the two periods using a generalized linear mixed model (GLMM). Correlations between assessments and changes in walking abilities during each period were analyzed. RESULTS After standard rehabilitation for 66.1 ± 36.9 days, a period of 17.6 ± 3.3 days of RAGT was safely performed. SWS increased during both periods. GLMM showed that the increase in cadence was influenced by standard rehabilitation, whereas the limited step length increase was influenced by RAGT. During RAGT, the increase in step length was related to an increase in hip flexor function. CONCLUSIONS Gait speed in patients with SCI increased after rehabilitation, including RAGT, in the short-term. This increase was associated with improved muscle function in hip flexion at the start of RAGT.Trial Registration: This study was registered with the UMIN Clinical Trials Registry (UMIN-CTR; UMIN000042025).
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Affiliation(s)
- Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Hirotaka Mutsuzaki
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Kazunori Koseki
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Koichi Iwai
- Center for Humanities and Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Ryoko Takeuchi
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Yutaka Kohno
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
- Department of Neurology, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
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Jimbo K, Miyata K, Yuine H, Takahama K, Yoshimura T, Shiba H, Yasumori T, Kikuchi N, Shiraishi H. Verification of the minimal clinically important difference of the Capabilities of Upper Extremity Test in patients with subacute spinal cord injury. J Spinal Cord Med 2023:1-8. [PMID: 37930635 DOI: 10.1080/10790268.2023.2273586] [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: 11/07/2023] Open
Abstract
CONTEXT The number of patients with cervical spinal cord injury (CSCI) is increasing, and the Capabilities of Upper Extremity Test (CUE-T) is recommended for introduction in clinical trials. We calculated the minimal clinically important difference (MCID) of the CUE-T using an adjustment model with an interval of 1 month. DESIGN This was a prospective study. SETTING This study was conducted with participants from the Chiba Rehabilitation Center in Japan. PARTICIPANTS The participants were patients with subacute CSCI. INTERVENTIONS The CUE-T and spinal cord independence measure (SCIM) III were performed twice within an interval of 1 month. OUTCOME MEASURES The MCID was calculated using an adjustment model based on logistic regression analysis. The participants were classified into an improvement group and a non-improvement group based on the amount of change in the two evaluations using the 10-point SCIM III MCID as an anchor. RESULTS There were 52 participants (56.8 ± 13.5 years old, 45 men/7 women) with complete or incomplete CSCI: 18 in the improvement group and 34 in the non-improvement group. A significant regression equation was obtained when calculating the MCID, and the total, hand, and side scores were 7.7, 2.0, and 3.7 points, respectively. CONCLUSION The calculated MCID of the CUE-T in this study was 7.7 points. The results of this study provide useful criteria for implementation in clinical trials. Future studies should use patient-reported outcomes, a more recommended anchor, and calculate the MCID using methods such as the patient's condition.
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Affiliation(s)
- Kazumasa Jimbo
- Graduate School of Health Sciences, Ibaraki Prefectural University of Health Sciences, Ami, Japan
- Department of Rehabilitation Treatment, Chiba Rehabilitation Center, Chiba, Japan
| | - Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ami, Japan
| | - Hiroshi Yuine
- Department of Occupational Therapy, Ibaraki Prefectural University of Health Sciences, Ami, Japan
| | - Kousuke Takahama
- Department of Rehabilitation Treatment, Chiba Rehabilitation Center, Chiba, Japan
| | - Tomohiro Yoshimura
- Department of Rehabilitation Treatment, Chiba Rehabilitation Center, Chiba, Japan
| | - Honoka Shiba
- Department of Rehabilitation Treatment, Chiba Rehabilitation Center, Chiba, Japan
| | - Taichi Yasumori
- Department of Rehabilitation Treatment, Chiba Rehabilitation Center, Chiba, Japan
| | - Naohisa Kikuchi
- Department of Rehabilitation Medicine, Chiba Rehabilitation Center, Chiba, Japan
| | - Hideki Shiraishi
- Department of Occupational Therapy, Ibaraki Prefectural University of Health Sciences, Ami, Japan
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Hong HA, Walden K, Laskin JJ, Wang D, Kurban D, Cheng CL, Guilbault L, Dagley E, Wong C, McCullum S, Gagnon DH, Lemay JF, Noonan VK, Musselman KE. Using the Standing and Walking Assessment Tool at Discharge Predicts Community Outdoor Walking Capacity in Persons With Traumatic Spinal Cord Injury. Phys Ther 2023; 103:pzad106. [PMID: 37561412 PMCID: PMC10799252 DOI: 10.1093/ptj/pzad106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/10/2023] [Accepted: 05/06/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE The Standing and Walking Assessment Tool (SWAT) standardizes the timing and content of walking assessments during inpatient rehabilitation by combining 12 stages ranging from lowest to highest function (0, 0.5, 1A, 1B, 1C, 2A, 2B, 2C, 3A, 3B, 3C, and 4) with 5 standard measures: the Berg Balance Scale, the modified Timed "Up & Go" test, the Activities-specific Balance Confidence Scale, the modified 6-Minute Walk Test, and the 10-Meter Walk Test (10MWT). This study aimed to determine if the SWAT at rehabilitation discharge could predict outdoor walking capacity 1-year after discharge in people with traumatic spinal cord injury. METHODS This retrospective study used data obtained from the Rick Hansen Spinal Cord Injury Registry from 2014 to 2020. Community outdoor walking capacity was measured using the Spinal Cord Independence Measure III (SCIM III) outdoor mobility score obtained 12 (±4) months after discharge. Of 206 study participants, 90 were community nonwalkers (ie, SCIM III score 0-3), 41 were community walkers with aids (ie, SCIM III score 4-6), and 75 were independent community walkers (ie, SCIM III score 7-8). Bivariate, multivariable regression, and an area under the receiver operating characteristic curve analyses were performed. RESULTS At rehabilitation discharge, 3 significant SWAT associations were confirmed: 0-3A with community nonwalkers, 3B/higher with community walkers with and without an aid, and 4 with independent community walkers. Moreover, at discharge, a higher (Berg Balance Scale, Activities-specific Balance Confidence Scale), faster (modified Timed "Up & Go," 10MWT), or further (10MWT) SWAT measure was significantly associated with independent community walking. Multivariable analysis indicated that all SWAT measures, except the 10MWT were significant predictors of independent community walking. Furthermore, the Activities-Specific Balance Confidence Scale had the highest area under the receiver operating characteristic score (0.91), demonstrating an excellent ability to distinguish community walkers with aids from independent community walkers. CONCLUSION The SWAT stage and measures at discharge can predict community outdoor walking capacity in persons with traumatic spinal cord injury. Notably, a patient's confidence in performing activities plays an important part in achieving walking ability in the community. IMPACT The discharge SWAT is useful to optimize discharge planning.
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Affiliation(s)
- Heather A Hong
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | - Kristen Walden
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | - James J Laskin
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | - Di Wang
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | - Dilnur Kurban
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | | | | | - Erica Dagley
- Nova Scotia Rehabilitation and Arthritis Centre, Halifax, Nova Scotia, Canada
| | - Chelsea Wong
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Shane McCullum
- Stan Cassidy Centre for Rehabilitation, Fredericton, New Brunswick, Canada
| | - Dany H Gagnon
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Site Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, Montréal, Québec, Canada
| | - Jean-François Lemay
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Site Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, Montréal, Québec, Canada
| | - Vanessa K Noonan
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | - Kristin E Musselman
- Department of Physical Therapy and Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
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Bluvshtein V, Catz A, Gelernter I, Kfir A, Front L, Michaeli D, Bizzarini E, Margalho P, Soeira TP, Kesiktas N, Aidinoff E. The net contribution of rehabilitation to improvement in performance in patients with spinal cord lesions in five countries. J Spinal Cord Med 2023:1-7. [PMID: 37861289 DOI: 10.1080/10790268.2023.2271200] [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: 10/21/2023] Open
Abstract
CONTEXT Change in ability realization reflects the main contribution of rehabilitation to improvement in the performance of daily activities in patients with spinal cord lesions (SCL). OBJECTIVE To assess the net effect of rehabilitation of patients with SCL and compare it between countries. METHODS We calculated the Spinal Cord Ability Realization Measurement Index (SCI-ARMI) and its change from admission to rehabilitation to discharge, for inpatients admitted to SCL units in five countries, between 2016 and 2019. We used chi-square tests, analysis of variance (ANOVA), McNemar's test, Pearson's correlations, and analysis of covariance (ANCOVA) to compare countries and patient groups and assess the relationships of various factors with SCI-ARMI gain during rehabilitation. RESULTS The study included 218 inpatients (67% males, age 52 ± 17). In Brazil, Israel, Italy, Portugal, and Turkiye, respectively, SCI-ARMI gain was 2 (SD = 15), 19 (SD = 17), 31 (SD = 23), 13 (SD = 15), and 16 (SD = 12). Yet, after controlling for admission SCI-ARMI and the time from SCL onset to the examination, the effect of the country on ability realization gain was found non-significant (P = 0.086). CONCLUSION The study confirmed that rehabilitation makes a net contribution to improvement in performance in patients with SCL, beyond the contribution of neurological recovery. After controlling for affecting factors, this contribution was quite similar in the participating units from different countries.
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Affiliation(s)
- Vadim Bluvshtein
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amiram Catz
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ilana Gelernter
- School of Mathematical Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Adi Kfir
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - Lilach Front
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - Dianne Michaeli
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
| | | | | | | | - Nur Kesiktas
- Istanbul Physical Medicine and Rehabilitation Hospital, University of Health Sciences, Turkiye
| | - Elena Aidinoff
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Basiratzadeh S, Hakimjavadi R, Baddour N, Michalowski W, Viktor H, Wai E, Stratton A, Kingwell S, Mac-Thiong JM, Tsai EC, Wang Z, Phan P. A data-driven approach to categorize patients with traumatic spinal cord injury: cluster analysis of a multicentre database. Front Neurol 2023; 14:1263291. [PMID: 37900603 PMCID: PMC10602788 DOI: 10.3389/fneur.2023.1263291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/05/2023] [Indexed: 10/31/2023] Open
Abstract
Background Conducting clinical trials for traumatic spinal cord injury (tSCI) presents challenges due to patient heterogeneity. Identifying clinically similar subgroups using patient demographics and baseline injury characteristics could lead to better patient-centered care and integrated care delivery. Purpose We sought to (1) apply an unsupervised machine learning approach of cluster analysis to identify subgroups of tSCI patients using patient demographics and injury characteristics at baseline, (2) to find clinical similarity within subgroups using etiological variables and outcome variables, and (3) to create multi-dimensional labels for categorizing patients. Study design Retrospective analysis using prospectively collected data from a large national multicenter SCI registry. Methods A method of spectral clustering was used to identify patient subgroups based on the following baseline variables collected since admission until rehabilitation: location of the injury, severity of the injury, Functional Independence Measure (FIM) motor, and demographic data (age, and body mass index). The FIM motor score, the FIM motor score change, and the total length of stay were assessed on the subgroups as outcome variables at discharge to establish the clinical similarity of the patients within derived subgroups. Furthermore, we discussed the relevance of the identified subgroups based on the etiological variables (energy and mechanism of injury) and compared them with the literature. Our study also employed a qualitative approach to systematically describe the identified subgroups, crafting multi-dimensional labels to highlight distinguishing factors and patient-focused insights. Results Data on 334 tSCI patients from the Rick Hansen Spinal Cord Injury Registry was analyzed. Five significantly different subgroups were identified (p-value ≤0.05) based on baseline variables. Outcome variables at discharge superimposed on these subgroups had statistically different values between them (p-value ≤0.05) and supported the notion of clinical similarity of patients within each subgroup. Conclusion Utilizing cluster analysis, we identified five clinically similar subgroups of tSCI patients at baseline, yielding statistically significant inter-group differences in clinical outcomes. These subgroups offer a novel, data-driven categorization of tSCI patients which aligns with their demographics and injury characteristics. As it also correlates with traditional tSCI classifications, this categorization could lead to improved personalized patient-centered care.
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Affiliation(s)
| | | | - Natalie Baddour
- Department of Mechanical Engineering, Faculty of Engineering, University of Ottawa, Ottawa, ON, Canada
| | | | - Herna Viktor
- School of Electrical Engineering and Computer Science, Faculty of Engineering, University of Ottawa, Ottawa, ON, Canada
| | - Eugene Wai
- Division of Orthopedic Surgery, Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada
- Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Alexandra Stratton
- Division of Orthopedic Surgery, Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada
- Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Stephen Kingwell
- Division of Orthopedic Surgery, Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada
- Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jean-Marc Mac-Thiong
- Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Eve C. Tsai
- Division of Neurosurgery, The Ottawa Hospital, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Zhi Wang
- Department of Orthopedic Surgery, University of Montreal Health Center, Montreal, QC, Canada
| | - Philippe Phan
- Division of Orthopedic Surgery, Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada
- Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Nascimento L, Fernandes C, Silva RM, Semitela Â, de Sousa BM, Marques PAAP, Vieira SI, Silva RF, Barroca N, Gonçalves G. Customizing 3D Structures of Vertically Aligned Carbon Nanotubes to Direct Neural Stem Cell Differentiation. Adv Healthc Mater 2023; 12:e2300828. [PMID: 37312636 DOI: 10.1002/adhm.202300828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/19/2023] [Indexed: 06/15/2023]
Abstract
Neural tissue-related illnesses have a high incidence and prevalence in society. Despite intensive research efforts to enhance the regeneration of neural cells into functional tissue, effective treatments are still unavailable. Here, a novel therapeutic approach based on vertically aligned carbon nanotube forests (VA-CNT forests) and periodic VA-CNT micropillars produced by thermal chemical vapor deposition is explored. In addition, honeycomb-like and flower-like morphologies are created. Initial viability testing reveals that NE-4C neural stem cells seeded on all morphologies survive and proliferate. In addition, free-standing VA-CNT forests and capillary-driven VA-CNT forests are created, with the latter demonstrating enhanced capacity to stimulate neuritogenesis and network formation under minimal differentiation medium conditions. This is attributed to the interaction between surface roughness and 3D-like morphology that mimics the native extracellular matrix, thus enhancing cellular attachment and communication. These findings provide a new avenue for the construction of electroresponsive scaffolds based on CNTs for neural tissue engineering.
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Affiliation(s)
- Luís Nascimento
- TEMA, Mechanical Engineering Department, University of Aveiro, Aveiro, 3810-193, Portugal
- Intelligent Systems Associate Laboratory (LASI), Aveiro, 3810-193, Portugal
| | - Cristiana Fernandes
- TEMA, Mechanical Engineering Department, University of Aveiro, Aveiro, 3810-193, Portugal
- Intelligent Systems Associate Laboratory (LASI), Aveiro, 3810-193, Portugal
| | - Ricardo M Silva
- CICECO Aveiro Insititute of Materials, University of Aveiro, Aveiro, 3810-193, Portugal
| | - Ângela Semitela
- TEMA, Mechanical Engineering Department, University of Aveiro, Aveiro, 3810-193, Portugal
- Intelligent Systems Associate Laboratory (LASI), Aveiro, 3810-193, Portugal
| | - Bárbara M de Sousa
- iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, 3810-193, Portugal
| | - Paula A A P Marques
- TEMA, Mechanical Engineering Department, University of Aveiro, Aveiro, 3810-193, Portugal
- Intelligent Systems Associate Laboratory (LASI), Aveiro, 3810-193, Portugal
| | - Sandra I Vieira
- iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, 3810-193, Portugal
| | - Rui F Silva
- CICECO Aveiro Insititute of Materials, University of Aveiro, Aveiro, 3810-193, Portugal
| | - Nathalie Barroca
- TEMA, Mechanical Engineering Department, University of Aveiro, Aveiro, 3810-193, Portugal
- Intelligent Systems Associate Laboratory (LASI), Aveiro, 3810-193, Portugal
| | - Gil Gonçalves
- TEMA, Mechanical Engineering Department, University of Aveiro, Aveiro, 3810-193, Portugal
- Intelligent Systems Associate Laboratory (LASI), Aveiro, 3810-193, Portugal
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Yang TW, Yoo DH, Huh S, Jang MH, Shin YB, Kim SH. Epidemiology and Assessment of Traumatic Spinal Cord Injury With Concomitant Brain Injury: An Observational Study in a Regional Trauma Center. Ann Rehabil Med 2023; 47:385-392. [PMID: 37907230 PMCID: PMC10620491 DOI: 10.5535/arm.23054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/10/2023] [Accepted: 08/19/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVE : To analyze the epidemiological information of patients with traumatic spinal cord injury (SCI) and concomitant traumatic brain injury (TBI) and to suggest points to be aware of during the initial physical examination of patients with SCI. METHODS : This study was a retrospective, observational study conducted in a regional trauma center. All the records of patients diagnosed with traumatic SCI between 2016 and 2020 were reviewed. A total of 627 patients with confirmed traumatic SCI were hospitalized. A retrospective study was conducted on 363 individuals. RESULTS : The epidemiological data of 363 individuals were investigated. Changes in American Spinal Injury Association Impairment Scale (AIS) scores in patients with SCI were evaluated. The initial evaluation was performed on average 11 days after the injury, and a follow-up examination was performed 43 days after. Fourteen of the 24 patients identified as having AIS A and SCI with concomitant TBI in the initial evaluation showed neurologic level of injury (NLI) recovery with AIS B or more. The conversion rate in patients with SCI and concomitant TBI exceeded that reported in previous studies in individuals with SCI. CONCLUSIONS : Physical, cognitive, and emotional impairments caused by TBI present significant challenges in rehabilitating patients with SCI. In this study, the influence of concomitant TBI lesions could have caused the initial AIS assessment to be incorrect.
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Affiliation(s)
- Tae Woong Yang
- Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Dong Ho Yoo
- Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sungchul Huh
- Department of Rehabilitation Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Myung Hun Jang
- Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Yong Beom Shin
- Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Sang Hun Kim
- Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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Sabirov D, Ogurcov S, Shulman I, Kabdesh I, Garanina E, Sufianov A, Rizvanov A, Mukhamedshina Y. Comparative Analysis of Cytokine Profiles in Cerebrospinal Fluid and Blood Serum in Patients with Acute and Subacute Spinal Cord Injury. Biomedicines 2023; 11:2641. [PMID: 37893015 PMCID: PMC10604120 DOI: 10.3390/biomedicines11102641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/12/2023] [Accepted: 09/18/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Cytokines are actively involved in the regulation of the inflammatory and immune responses and have crucial importance in the outcome of spinal cord injuries (SCIs). Examining more objective and representative indicators of the patient's condition is still required to reveal the fundamental patterns of the abovementioned posttraumatic processes, including the identification of changes in the expression of cytokines. METHODS We performed a dynamic (3, 7, and 14 days post-injury (dpi)) extended multiplex analysis of cytokine profiles in both CSF and blood serum of SCI patients with baseline American Spinal Injury Association Impairment Scale grades of A. RESULTS The data obtained showed a large elevation of IL6 (>58 fold) in CSF and IFN-γ (>14 fold) in blood serum at 3 dpi with a downward trend as the post-traumatic period increases. The level of cytokine CCL26 was significantly elevated in both CSF and blood serum at 3 days post-SCI, while other cytokines did not show the same trend in the different biosamples. CONCLUSIONS The dynamic changes in cytokine levels observed in our study can explore the relationships with the SCI region and injury severity, paving the way for a better understanding of the pathophysiology of SCI and potentially more targeted and personalized therapeutic interventions.
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Affiliation(s)
- Davran Sabirov
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, 420008 Kazan, Russia
| | - Sergei Ogurcov
- Neurosurgical Department No. 2, Republic Clinical Hospital, 420138 Kazan, Russia
| | - Ilya Shulman
- Neurosurgical Department No. 2, Republic Clinical Hospital, 420138 Kazan, Russia
| | - Ilyas Kabdesh
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, 420008 Kazan, Russia
| | - Ekaterina Garanina
- Department of Genetics, Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, 420008 Kazan, Russia
| | - Albert Sufianov
- Department of Neurosurgery, Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 119991 Moscow, Russia
- The Research and Educational Institute of Neurosurgery, Peoples’ Friendship University of Russia (RUDN), 117198 Moscow, Russia
| | - Albert Rizvanov
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, 420008 Kazan, Russia
| | - Yana Mukhamedshina
- OpenLab “Gene and Cell Technologies”, Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, 420008 Kazan, Russia
- Department of Histology, Cytology and Embryology, Kazan State Medical University, 420012 Kazan, Russia
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Ding Y, Jiang X, Li L, Dai Q, Tao L, Liu J, Li Z, Wang J, Liao C, Gao X. Effects of comprehensive functional nursing on functional recovery and quality of life in patients with spinal cord injury. Medicine (Baltimore) 2023; 102:e35102. [PMID: 37747020 PMCID: PMC10519484 DOI: 10.1097/md.0000000000035102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/17/2023] [Accepted: 08/16/2023] [Indexed: 09/26/2023] Open
Abstract
This study evaluated the effects of comprehensive functional nursing on functional recovery and quality of life in patients with spinal cord injuries (SCIs). A total of 214 patients with SCIs treated in our hospital from October 2019 to October 2021 were included in the retrospective analysis and divided into a general care group (n = 107) and a comprehensive care group (n = 107), based on the care that they received. Patients in the general care group received general functional nursing, whereas those in the comprehensive care group received a comprehensive functional nursing intervention. The Rivermead Mobility Index (RMI), Barthel Index (BI), and Berg Balance Score (BBS) were used to evaluate patient neurobehavioral ability before and after nursing. Changes in cardiopulmonary function indexes, left ventricular end-diastolic dimension (LVEDD), left ventricular end-systolic dimension (LVESD), vital capacity (VC), forced expiratory volume in 1 second (FEV1), FEV1/FVC, and maximal voluntary ventilation (MVV) were measured before and after nursing. The number of micturition, maximum micturition volume, bladder volume, residual urine volume, and lower urinary tract symptom (LUTS) score were recorded, and the improvement in bladder function were measured before and after nursing. The Hamilton Anxiety Scale (HAMA) and Beck Depression Inventory (BDI) scores were used to evaluate patients' emotional state. After nursing, the RMI, BI, BBS score, FEV1, FEV1/FVC, MVV, maximum micturition volume, bladder volume, and SF-36 scores of the comprehensive care group were significantly higher than those of the general care group, and the LVEDD, LVESD, micturition time, residual urine volume, and LUTS, HAMA, and BDI scores of the comprehensive care group were significantly lower than those of the general care group. In patients with SCIs, comprehensive functional nursing can promote the recovery of neurocognition, bladder function, and cardiorespiratory function, and improve their quality of life. Comprehensive functional nursing is worthy of clinical application.
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Affiliation(s)
- Yang Ding
- First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xixuan Jiang
- First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Lunlan Li
- First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Qing Dai
- First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Lei Tao
- First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jing Liu
- First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Zhen Li
- First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jing Wang
- First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Chenxia Liao
- First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xin Gao
- Anhui Medical University, Hefei, Anhui, China
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Harley-Troxell ME, Steiner R, Advincula RC, Anderson DE, Dhar M. Interactions of Cells and Biomaterials for Nerve Tissue Engineering: Polymers and Fabrication. Polymers (Basel) 2023; 15:3685. [PMID: 37765540 PMCID: PMC10536046 DOI: 10.3390/polym15183685] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
Neural injuries affect millions globally, significantly impacting their quality of life. The inability of these injuries to heal, limited ability to regenerate, and the lack of available treatments make regenerative medicine and tissue engineering a promising field of research for developing methods for nerve repair. This review evaluates the use of natural and synthetic polymers, and the fabrication methods applied that influence a cell's behavior. Methods include cross-linking hydrogels, incorporation of nanoparticles, and 3D printing with and without live cells. The endogenous cells within the injured area and any exogenous cells seeded on the polymer construct play a vital role in regulating healthy neural activity. This review evaluates the body's local and systemic reactions to the implanted materials. Although numerous variables are involved, many of these materials and methods have exhibited the potential to provide a biomaterial environment that promotes biocompatibility and the regeneration of a physical and functional nerve. Future studies may evaluate advanced methods for modifying material properties and characterizing the tissue-biomaterial interface for clinical applications.
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Affiliation(s)
- Meaghan E. Harley-Troxell
- Tissue Engineering and Regenerative Medicine, Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996, USA; (M.E.H.-T.); (R.S.); (D.E.A.)
| | - Richard Steiner
- Tissue Engineering and Regenerative Medicine, Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996, USA; (M.E.H.-T.); (R.S.); (D.E.A.)
| | - Rigoberto C. Advincula
- Department of Chemical and Biomolecular Engineering, University of Tennessee, Knoxville, TN 37996, USA;
- Oak Ridge National Laboratory, Center for Nanophase Materials Sciences, Oak Ridge, TN 37831, USA
| | - David E. Anderson
- Tissue Engineering and Regenerative Medicine, Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996, USA; (M.E.H.-T.); (R.S.); (D.E.A.)
| | - Madhu Dhar
- Tissue Engineering and Regenerative Medicine, Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996, USA; (M.E.H.-T.); (R.S.); (D.E.A.)
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Sangari S, Chen B, Grover F, Salsabili H, Sheth M, Gohil K, Hobbs S, Olson A, Eisner-Janowicz I, Anschel A, Kim K, Chen D, Kessler A, Heinemann AW, Oudega M, Kwon BK, Kirshblum S, Guest JD, Perez MA. Spasticity Predicts Motor Recovery for Patients with Subacute Motor Complete Spinal Cord Injury. Ann Neurol 2023; 95:71-86. [PMID: 37606612 DOI: 10.1002/ana.26772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/25/2023] [Accepted: 08/17/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVE A motor complete spinal cord injury (SCI) results in the loss of voluntary motor control below the point of injury. Some of these patients can regain partial motor function through inpatient rehabilitation; however, there is currently no biomarker to easily identify which patients have this potential. Evidence indicates that spasticity could be that marker. Patients with motor complete SCI who exhibit spasticity show preservation of descending motor pathways, the pathways necessary for motor signals to be carried from the brain to the target muscle. We hypothesized that the presence of spasticity predicts motor recovery after subacute motor complete SCI. METHODS Spasticity (Modified Ashworth Scale and pendulum test) and descending connectivity (motor evoked potentials) were tested in the rectus femoris muscle in patients with subacute motor complete (n = 36) and motor incomplete (n = 30) SCI. Motor recovery was assessed by using the International Standards for Neurological Classification of Spinal Cord Injury and the American Spinal Injury Association Impairment Scale (AIS). All measurements were taken at admission and discharge from inpatient rehabilitation. RESULTS We found that motor complete SCI patients with spasticity improved in motor scores and showed AIS conversion to either motor or sensory incomplete. Conversely, patients without spasticity showed no changes in motor scores and AIS conversion. In incomplete SCI patients, motor scores improved and AIS conversion occurred regardless of spasticity. INTERPRETATION These findings suggest that spasticity represents an easy-to-use clinical outcome that might help to predict motor recovery after severe SCI. This knowledge can improve inpatient rehabilitation effectiveness for motor complete SCI patients. ANN NEUROL 2023.
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Affiliation(s)
| | - Bing Chen
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | | | | | | | | | - Sara Hobbs
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | | | | | - Alan Anschel
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
| | - Ki Kim
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
| | - David Chen
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
| | - Allison Kessler
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
| | - Allen W Heinemann
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
| | - Martin Oudega
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, USA
- Edward Hines Jr. VA Hospital, Hines, Illinois, USA
- Department of Neuroscience, Northwestern University, Chicago, Illinois, USA
| | - Brian K Kwon
- International Collaboration on Repair Discoveries (ICORD), Department of Orthopedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Steven Kirshblum
- Kessler Institute for Rehabilitation, Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - James D Guest
- The Miami Project to Cure Paralysis, University of Miami, Miami, Florida, USA
| | - Monica A Perez
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, USA
- Edward Hines Jr. VA Hospital, Hines, Illinois, USA
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Neuhauser C, Sailer CO, Najmanova K, Baumberger M, Paez-Granados D, Schaefer DJ, Wettstein R, Scheel-Sailer A. Risk constellation of hospital acquired pressure injuries in patients with a spinal cord injury/ disorder - focus on time since spinal cord injury/ disorder and patients' age. Spinal Cord 2023; 61:453-459. [PMID: 37407644 DOI: 10.1038/s41393-023-00910-5] [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: 10/02/2022] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVES The aim of this study was to evaluate how time since spinal cord injury/disorder (SCI/D) and patients' age influence risk constellation for hospital acquired pressure injuries (HAPI) in patients with a SCI/D. SETTING Acute care and rehabilitation clinic specialized in SCI/D. METHODS We collected patients' characteristics and 85 risk factors for HAPI development in adults with SCI/D with at least one HAPI during their inpatient stay between August 2018 and December 2019. We analyzed patients' characteristics and HAPI risk factors using descriptive statistics according to time since SCI/D ( < 1 year, 1-15 years, > 15 years) and patients' age (18-35 years, 35-65 years, > 65 years). RESULTS We identified 182 HAPI in 96 patients. Comparing patients with SCI/D < 1 year with the other groups, autonomic dysreflexia (p < 0.001), abnormal body temperature (p = 0.001), hypertensive episode (p = 0.005), and pneumonia (p < 0.001) occurred more frequently; mean hemoglobin (p < 0.001), albumin (p = 0.002) and vitamin D levels (p = 0.013) were significantly lower, and patients with time since SCI/D < 1 year scored fewer points (10-12) on the Braden Scale (p < 0.001). Comparing groups per patients' age, only the SCIPUS score was higher in patients > 65 years compared to the other two groups (p = 0.002). CONCLUSIONS Different risk factor constellation seem to be underlying HAPI development with more differences in patients time since SCI/D than patients' age. Awareness of these differences in risk factor constellation depending on time since SCI/D in these patients might lead to different HAPI prevention strategies. SPONSORSHIP The study team didn't receive any additional sponsorship.
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Affiliation(s)
| | - Clara O Sailer
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Department of Clinical Research, University of Basel, Basel, Switzerland
| | | | | | - Diego Paez-Granados
- SCAI-Lab, Department of Health Science and Technology, ETH Zürich, Zürich, Switzerland
| | - Dirk Johannes Schaefer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland
| | - Reto Wettstein
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland
| | - Anke Scheel-Sailer
- Swiss Paraplegic Centre, Nottwil, Switzerland.
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
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Hejrati N, Wong R, Khazaei M, Fehlings MG. How can clinical safety and efficacy concerns in stem cell therapy for spinal cord injury be overcome? Expert Opin Biol Ther 2023; 23:883-899. [PMID: 37545020 DOI: 10.1080/14712598.2023.2245321] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/03/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Spinal cord injury (SCI) can lead to severe neurological dysfunction. Despite scientific and medical advances, clinically effective regenerative therapies including stem cells are lacking for SCI. AREAS COVERED This paper discusses translational challenges related to the safe, effective use of stem cells for SCI, with a focus on mesenchymal stem cells (MSCs), neural stem cells (NSCs), Schwann cells (SCs), olfactory ensheathing cells (OECs), oligodendrocyte precursor cells (OPCs), embryonic stem cells (ESCs), and induced pluripotent stem cells (iPSCs). We discuss approaches to enhance the efficacy of cell-based strategies by i) addressing patient heterogeneity and enhancing patient selection; ii) selecting cell type, cell source, cell developmental stage, and delivery technique; iii) enhancing graft integration and mitigating immune-mediated graft rejection; and iv) ensuring availability of cells. Additionally, we review strategies to optimize outcomes including combinatorial use of rehabilitation and discuss ways to mitigate potential risks of tumor formation associated with stem cell-based strategies. EXPERT OPINION Basic science research will drive translational advances to develop stem cell-based therapies for SCI. Genetic, serological, and imaging biomarkers may enable individualization of cell-based treatments. Moreover, combinatorial strategies will be required to enhance graft survival, migration and functional integration, to enable precision-based intervention.
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Affiliation(s)
- Nader Hejrati
- Division of Genetics and Development, Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Department of Neurosurgery & Spine Center of Eastern Switzerland, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Raymond Wong
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Mohamad Khazaei
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Michael G Fehlings
- Division of Genetics and Development, Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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Chen S, Li G, Li F, Wang G, Wang Q. A dynamic nomogram for predicting the probability of irreversible neurological dysfunction after cervical spinal cord injury: research based on clinical features and MRI data. BMC Musculoskelet Disord 2023; 24:459. [PMID: 37277760 DOI: 10.1186/s12891-023-06570-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/25/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Irreversible neurological dysfunction (IND) is an adverse event after cervical spinal cord injury (CSCI). However, there is still a shortage of objective criteria for the early prediction of neurological function. We aimed to screen independent predictors of IND and use these findings to construct a nomogram that could predict the development of neurological function in CSCI patients. METHODS Patients with CSCI attending the Affiliated Hospital of Southwest Medical University between January 2014 and March 2021 were included in this study. We divided the patients into two groups: reversible neurological dysfunction (RND) and IND. The independent predictors of IND in CSCI patients were screened using the regularization technique to construct a nomogram, which was finally converted into an online calculator. Concordance index (C-index), calibration curves analysis and decision curve analysis (DCA) evaluated the model's discrimination, calibration, and clinical applicability. We tested the nomogram in an external validation cohort and performed internal validation using the bootstrap method. RESULTS We enrolled 193 individuals with CSCI in this study, including IND (n = 75) and RND (n = 118). Six features, including age, American spinal injury association Impairment Scale (AIS) grade, signal of spinal cord (SC), maximum canal compromise (MCC), intramedullary lesion length (IMLL), and specialized institution-based rehabilitation (SIBR), were included in the model. The C-index of 0.882 from the training set and its externally validated value of 0.827 demonstrated the model's prediction accuracy. Meanwhile, the model has satisfactory actual consistency and clinical applicability, verified in the calibration curve and DCA. CONCLUSION We constructed a prediction model based on six clinical and MRI features that can be used to assess the probability of developing IND in patients with CSCI.
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Affiliation(s)
- Si Chen
- Department of Orthopaedics, People's Hospital of Chongqing Banan District, Chongqing, China
| | - Guangzhou Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Sichuan, 646000, China
| | - Feng Li
- Department of Orthopaedics, The Affiliated Chengdu 363 Hospital of Southwest Medical University, Chengdu, China
| | - Gaoju Wang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Sichuan, 646000, China
| | - Qing Wang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Sichuan, 646000, China.
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Tarnacka B, Korczyński B, Frasuńska J. Impact of Robotic-Assisted Gait Training in Subacute Spinal Cord Injury Patients on Outcome Measure. Diagnostics (Basel) 2023; 13:diagnostics13111966. [PMID: 37296818 DOI: 10.3390/diagnostics13111966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
The improvement of walking ability is a primary goal for spinal cord injury (SCI) patients. Robotic-assisted gait training (RAGT) is an innovative method for its improvement. This study evaluates the influence of RAGT vs. dynamic parapodium training (DPT) in improving gait motor functions in SCI patients. In this single-centre, single-blinded study, we enrolled 105 (39 and 64 with complete and incomplete SCI, respectively) patients. The investigated subjects received gait training with RAGT (experimental S1-group) and DPT (control S0-group), with six training sessions per week over seven weeks. The American Spinal Cord Injury Association Impairment Scale Motor Score (MS), Spinal Cord Independence Measure, version-III (SCIM-III), Walking Index for Spinal Cord Injury, version-II (WISCI-II), and Barthel Index (BI) were assessed in each patient before and after sessions. Patients with incomplete SCI assigned to the S1 rehabilitation group achieved more significant improvement in MS [2.58 (SE 1.21, p < 0.05)] and WISCI-II [3.07 (SE 1.02, p < 0.01])] scores in comparison with patients assigned to the S0 group. Despite the described improvement in the MS motor score, no progression between grades of AIS (A to B to C to D) was observed. A nonsignificant improvement between the groups for SCIM-III and BI was found. RAGT significantly improved gait functional parameters in SCI patients in comparison with conventional gait training with DPT. RAGT is a valid treatment option in SCI patients in the subacute phase. DPT should not be recommended for patients with incomplete SCI (AIS-C); in those patients, RAGT rehabilitation programs should be taken into consideration.
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Affiliation(s)
- Beata Tarnacka
- Department of Rehabilitation, Medical University of Warsaw, 02-637 Warsaw, Poland
- Research Institute for Innovative Methods of Rehabilitation of Patients with Spinal Cord Injury, Health Resort Kamień Pomorski, 72-400 Kamień Pomorski, Poland
| | - Bogumił Korczyński
- Research Institute for Innovative Methods of Rehabilitation of Patients with Spinal Cord Injury, Health Resort Kamień Pomorski, 72-400 Kamień Pomorski, Poland
| | - Justyna Frasuńska
- Department of Rehabilitation, Medical University of Warsaw, 02-637 Warsaw, Poland
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Dai CQ, Gao M, Lin XD, Xue BJ, Liang Y, Xu ML, Wu XB, Cheng GQ, Hu X, Zhao CG, Yuan H, Sun XL. Primary motor hand area corticospinal excitability indicates overall functional recovery after spinal cord injury. Front Neurol 2023; 14:1175078. [PMID: 37333013 PMCID: PMC10273270 DOI: 10.3389/fneur.2023.1175078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Background After spinal cord injury (SCI), the excitability of the primary motor cortex (M1) lower extremity area decreases or disappears. A recent study reported that the M1 hand area of the SCI patient encodes the activity information of both the upper and lower extremities. However, the characteristics of the M1 hand area corticospinal excitability (CSE) changes after SCI and its correlation with extremities motor function are still unknown. Methods A retrospective study was conducted on the data of 347 SCI patients and 80 healthy controls on motor evoked potentials (MEP, reflection of CSE), extremity motor function, and activities of daily living (ADL) ability. Correlation analysis and multiple linear regression analysis were conducted to analyze the relationship between the degree of MEP hemispheric conversion and extremity motor function/ADL ability. Results The CSE of the dominant hemisphere M1 hand area decreased in SCI patients. In 0-6 m, AIS A grade, or non-cervical injury SCI patients, the degree of M1 hand area MEP hemispheric conversion was positively correlated with total motor score, lower extremity motor score (LEMS), and ADL ability. Multiple linear regression analysis further confirmed the contribution of MEP hemispheric conversion degree in ADL changes as an independent factor. Conclusion The closer the degree of M1 hand area MEP hemispheric conversion is to that of healthy controls, the better the extremity motor function/ADL ability patients achieve. Based on the law of this phenomenon, targeted intervention to regulate the excitability of bilateral M1 hand areas might be a novel strategy for SCI overall functional recovery.
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Affiliation(s)
- Chun-Qiu Dai
- Department of Rehabilitation Medicine, Xi-Jing Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, China
- Lintong Rehabilitation and Convalescent Centre, Xi'an, China
| | - Ming Gao
- Department of Rehabilitation Medicine, Xi-Jing Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, China
| | - Xiao-Dong Lin
- Department of Rehabilitation Medicine, Xi-Jing Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, China
| | - Bai-Jie Xue
- Department of Rehabilitation Medicine, Xi-Jing Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, China
| | - Ying Liang
- Department of Health Statistics, Air Force Medical University (Fourth Military Medical University), Xi’an, China
| | - Mu-Lan Xu
- Department of Rehabilitation Medicine, Xi-Jing Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, China
| | - Xiang-Bo Wu
- Department of Rehabilitation Medicine, Xi-Jing Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, China
| | - Gui-Qing Cheng
- Department of Rehabilitation Medicine, Xi-Jing Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, China
| | - Xu Hu
- Department of Rehabilitation Medicine, Xi-Jing Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, China
| | - Chen-Guang Zhao
- Department of Rehabilitation Medicine, Xi-Jing Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, China
| | - Hua Yuan
- Department of Rehabilitation Medicine, Xi-Jing Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, China
| | - Xiao-Long Sun
- Department of Rehabilitation Medicine, Xi-Jing Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, China
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Stukas S, Cooper J, Gill J, Fallah N, Skinnider MA, Belanger L, Ritchie L, Tsang A, Dong K, Streijger F, Street J, Paquette S, Ailon T, Dea N, Charest-Morin R, Fisher CG, Bailey CS, Dhall S, Mac-Thiong JM, Wilson JR, Christie S, Dvorak MF, Wellington CL, Kwon BK. Association of CSF and Serum Neurofilament Light and Glial Fibrillary Acidic Protein, Injury Severity, and Outcome in Spinal Cord Injury. Neurology 2023; 100:e1221-e1233. [PMID: 36599698 PMCID: PMC10033160 DOI: 10.1212/wnl.0000000000206744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/15/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Traumatic spinal cord injury (SCI) is highly heterogeneous, and tools to better delineate pathophysiology and recovery are needed. Our objective was to profile the response of 2 biomarkers, neurofilament light (NF-L) and glial fibrillary acidic protein (GFAP), in the serum and CSF of patients with acute SCI to evaluate their ability to objectively characterize injury severity and predict neurologic recovery. METHODS Blood and CSF samples were obtained from prospectively enrolled patients with acute SCI through days 1-4 postinjury, and the concentration of NF-L and GFAP was quantified using Simoa technology. Neurologic assessments defined the ASIA Impairment Scale (AIS) grade and motor score (MS) at presentation and 6 months postinjury. RESULTS One hundred eighteen patients with acute SCI (78 AIS A, 20 AIS B, and 20 AIS C) were enrolled, with 113 (96%) completing 6-month follow-up. NF-L and GFAP levels were strongly associated between paired serum and CSF specimens, were both increased with injury severity, and distinguished among baseline AIS grades. Serum NF-L and GFAP were significantly (p = 0.02 to <0.0001) higher in AIS A patients who did not improve at 6 months, predicting AIS grade conversion with a sensitivity and specificity (95% CI) of 76% (61, 87) and 77% (55, 92) using NF-L and 72% (57, 84) and 77% (55, 92) using GFAP at 72 hours, respectively. Independent of clinical baseline assessment, a serum NF-L threshold of 170 pg/mL at 72 hours predicted those patients who would be classified as motor complete (AIS A/B) compared with motor incomplete (AIS C/D) at 6 months with a sensitivity of 87% (76, 94) and specificity of 84% (69, 94); a serum GFAP threshold of 13,180 pg/mL at 72 hours yielded a sensitivity of 90% (80, 96) and specificity of 84% (69, 94). DISCUSSION The potential for NF-L and GFAP to classify injury severity and predict outcome after acute SCI will be useful for patient stratification and prognostication in clinical trials and inform communication of prognosis. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that higher serum NF-L and GFAP are associated with worse neurological outcome after acute SCI. TRIAL REGISTRATION INFORMATION Registered on ClinicalTrials.gov: NCT00135278 (March 2006) and NCT01279811 (January 2012).
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Affiliation(s)
- Sophie Stukas
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Jennifer Cooper
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Jasmine Gill
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Nader Fallah
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Michael A Skinnider
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Lise Belanger
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Leanna Ritchie
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Angela Tsang
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Kevin Dong
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Femke Streijger
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - John Street
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Scott Paquette
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Tamir Ailon
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Nicolas Dea
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Raphaele Charest-Morin
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Charles G Fisher
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Christopher S Bailey
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Sanjay Dhall
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Jean-Marc Mac-Thiong
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Jefferson R Wilson
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Sean Christie
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Marcel F Dvorak
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Cheryl L Wellington
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada
| | - Brian K Kwon
- From the Djavad Mowafaghian Centre for Brain Health (S.S., J.C., J.G., C.L.W.), Department of Pathology and Laboratory Medicine (S.S, J,C, J.G.,C.L.W.) Division of Neurology, Department of Medicine (N.F.), Division of Neurosurgery (S.P., T.A., N.D.), Michael Smith Laboratories (M.A.S.), and School of Biomedical Engineering (C.L.W.), University of British Columbia, Vancouver, British Columbia; Praxis Spinal Cord Institute (N.F.), and Vancouver Spine Research Program (L.B., L.R., A.T.), Vancouver General Hospital, Blusson Spinal Cord Center, Vancouver, British Columbia; International Collaboration on Repair Discoveries (ICORD) (K.D., F.S., J.S., M.F.D., C.L.W., B.K.K.) and Vancouver Spine Surgery Institute, Department of Orthopaedics (J.S., R.C.-M., C.G.F., M.F.D., B.K.K.), University of British Columbia, Blusson Spinal Cord Center, Vancouver, British Columbia; Division of Orthopaedics (C.S.B.), Schulich School of Medicine, University of Western Ontario, London, Canada; Department of Neurosurgery (S.D.), University of California San Francisco; Department of Surgery (J-M., M-T.), Hôpital du Sacré-Coeur de Montréal, Quebec; Department of Surgery (J.-M., M.-T.), Chu Sainte-Justine, University of Montreal, Quebec; Division of Neurosurgery (J.R.W.), University of Toronto, St. Michael's Hospital, Ontario; and Division of Neurosurgery (S.C.), Halifax Infirmary, Dalhousie University, Nova Scotia, Canada.
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Xu T, Gao P, Huang Y, Wu M, Yi J, Zhou Z, Zhao X, Jiang T, Liu H, Qin T, Yang Z, Wang X, Bao T, Chen J, Zhao S, Yin G. Git1-PGK1 interaction achieves self-protection against spinal cord ischemia-reperfusion injury by modulating Keap1/Nrf2 signaling. Redox Biol 2023; 62:102682. [PMID: 36963288 PMCID: PMC10053403 DOI: 10.1016/j.redox.2023.102682] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 03/22/2023] Open
Abstract
Spinal cord ischemia-reperfusion (IR) injury (SCIRI) is a significant secondary injury that causes damage to spinal cord neurons, leading to the impairment of spinal cord sensory and motor functions. Excessive reactive oxygen species (ROS) production is considered one critical mechanism of neuron damage in SCIRI. Nonetheless, the molecular mechanisms underlying the resistance of neurons to ROS remain elusive. Our study revealed that the deletion of Git1 in mice led to poor recovery of spinal cord motor function after SCIRI. Furthermore, we discovered that Git1 has a beneficial effect on neuron resistance to ROS production. Mechanistically, Git1 interacted with PGK1, regulated PGK1 phosphorylation at S203, and affected the intermediate products of glycolysis in neurons. The influence of Git1 on glycolysis regulates the dimerization of Keap1, which leads to changes in Nrf2 ubiquitination and plays a role in resisting ROS. Collectively, we show that Git1 regulates the Keap1/Nrf2 axis to resist ROS in a PGK1-dependent manner and thus is a potential therapeutic target for SCIRI.
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Affiliation(s)
- Tao Xu
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China; Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School Nanjing, 210008, China; Jiangsu Institute of Functional Reconstruction and Rehabilitation, Nanjing, Jiangsu, 210029, China
| | - Peng Gao
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China; Jiangsu Institute of Functional Reconstruction and Rehabilitation, Nanjing, Jiangsu, 210029, China
| | - Yifan Huang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China; Jiangsu Institute of Functional Reconstruction and Rehabilitation, Nanjing, Jiangsu, 210029, China
| | - Mengyuan Wu
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China; Jiangsu Institute of Functional Reconstruction and Rehabilitation, Nanjing, Jiangsu, 210029, China
| | - Jiang Yi
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China; Jiangsu Institute of Functional Reconstruction and Rehabilitation, Nanjing, Jiangsu, 210029, China
| | - Zheng Zhou
- Department of Emergency Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China; Jiangsu Institute of Functional Reconstruction and Rehabilitation, Nanjing, Jiangsu, 210029, China
| | - Xuan Zhao
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China; Jiangsu Institute of Functional Reconstruction and Rehabilitation, Nanjing, Jiangsu, 210029, China
| | - Tao Jiang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China; Jiangsu Institute of Functional Reconstruction and Rehabilitation, Nanjing, Jiangsu, 210029, China
| | - Hao Liu
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China; Jiangsu Institute of Functional Reconstruction and Rehabilitation, Nanjing, Jiangsu, 210029, China
| | - Tao Qin
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China; Jiangsu Institute of Functional Reconstruction and Rehabilitation, Nanjing, Jiangsu, 210029, China
| | - Zhenqi Yang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China; Jiangsu Institute of Functional Reconstruction and Rehabilitation, Nanjing, Jiangsu, 210029, China
| | - Xiaowei Wang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China; Jiangsu Institute of Functional Reconstruction and Rehabilitation, Nanjing, Jiangsu, 210029, China
| | - Tianyi Bao
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China; Jiangsu Institute of Functional Reconstruction and Rehabilitation, Nanjing, Jiangsu, 210029, China
| | - Jian Chen
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China; Jiangsu Institute of Functional Reconstruction and Rehabilitation, Nanjing, Jiangsu, 210029, China.
| | - Shujie Zhao
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China; Jiangsu Institute of Functional Reconstruction and Rehabilitation, Nanjing, Jiangsu, 210029, China.
| | - Guoyong Yin
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China; Jiangsu Institute of Functional Reconstruction and Rehabilitation, Nanjing, Jiangsu, 210029, China.
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Chen J, Neo EJR, Tan YL. Complete spinal cord injury from postoperative seroma following scoliosis surgery: A case report with favorable ambulatory outcomes after comprehensive rehabilitation. J Spinal Cord Med 2023; 46:337-340. [PMID: 35981136 PMCID: PMC9987742 DOI: 10.1080/10790268.2022.2108661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
CONTEXT Postoperative seroma is a known complication following spine deformity surgery. However, complete spinal cord injury (SCI) due to postoperative seroma is rare. Rehabilitation strategies and outcomes of SCI associated with postoperative seroma have been inadequately described. FINDINGS A 15-year-old female experienced inadvertent durotomy during pinal deformity correction surgery for idiopathic adolescent scoliosis. Despite immediate decompressive laminectomy, she developed complete loss of motor and sensory function with neurological level of injury at T10 immediately following the surgery. Urgent magnetic resonance imaging revealed cord compression due to seroma. Decompressive surgery was performed 48 h later and timely intensive rehabilitation was provided for 3 months, which included the use of robotic-assisted gait training (RAGT) to maximize neurological recovery. She demonstrated impressive improvement from grade A to D on the American Spinal Injury Association Impairment Scale and regained functional ambulation over the 3-month period. We describe a comprehensive rehabilitation program to manage SCI associated with postoperative seroma, entailing the use of a robotic gait device for locomotor training. The progression of the patient's neurological status and functional outcomes was documented accordingly. CONCLUSION/CLINICAL RELEVANCE Complete SCI due to seroma, a surgical complication of corrective scoliosis surgery, is rare. However, prompt postoperative examination should be performed routinely in anticipation of neurological deterioration. Early rehabilitation comprising of gait re-training and the use of RAGT might enhance the lower-limb motor strength and functional recovery.
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Affiliation(s)
- Jing Chen
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore
| | | | - Yeow Leng Tan
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore
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Preservation of functional descending input to paralyzed upper extremity muscles in motor complete cervical spinal cord injury. Clin Neurophysiol 2023; 150:56-68. [PMID: 37004296 DOI: 10.1016/j.clinph.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/13/2023] [Accepted: 03/01/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Spinal cord injury (SCI) is classified as complete or incomplete depending on the extent of sensorimotor preservation below the injury level. However, individuals with complete SCIs can voluntarily activate paralyzed lower limb muscles alone or by engaging non-paralyzed muscles during neurophysiological assessments, indicating presence of residual pathways across the injury. However, similar phenomena have not been explored for the upper extremity (UE) muscles following cervical SCIs. METHODS Eighteen individuals with motor complete cervical SCI (AIS A or B) and five age-matched non-injured (NI) individuals performed various UE events against manual resistance during functional neurophysiological assessment (FNPA), and electromyographic (EMG) activity was recorded from UE muscles. RESULTS Our findings demonstrated i) voluntary activation of clinically paralyzed muscles as evident from EMG readouts, ii) increased activity in these muscles during events engaging muscles above the injury level, iii) reduced spectral properties of paralyzed muscles in SCI compared to NI participants. CONCLUSIONS Functional EMG activity in clinically paralyzed muscles indicate presence of residual pathways across the injury establishing supralesional control over the sublesional neural circuitry. SIGNIFICANCE The findings may help explain the neurophysiological basis for UE recovery and can be exploited in designing rehabilitation techniques to facilitate UE recovery following cervical SCIs.
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