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Poutanen J, Savolainen S, Shulga A, Arokoski J, Hiekkala S. ICF-linking and psychometric properties of upper extremity mobility outcome measures in spinal cord injury - a scoping review. J Spinal Cord Med 2024; 47:201-213. [PMID: 36622355 PMCID: PMC10885769 DOI: 10.1080/10790268.2022.2161867] [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: 01/10/2023] Open
Abstract
OBJECTIVE The purpose of this study was to explore the outcome measures used in upper extremity rehabilitation and research in spinal cord injury and to investigate their psychometry. DESIGN Scoping review. DATA SOURCES PubMed, the Cochrane library, PEDro, Medline (Ovid). ELIGIBILITY CRITERIA FOR SELECTING STUDIES The search process and study selection was carried out as follows: Firstly, a systematic search was carried out for articles on upper extremity rehabilitation after SCI. Performance or observational outcome measures which were designed for a clinical setting were collected from selected studies. Secondly, eligible outcome measures were linked to the ICF. The ICF-linked outcome measures were further screened for inclusion according to how comprehensively they covered ICF categories. Finally, a search of the selected outcome measures was performed to investigate their psychometry. RESULTS A total of four outcome measures and nine psychometric studies were selected for the scoping review; six studies addressed GRASSP, one addressed AuSpinal, one addressed SHFT and one addressed TRI-HFT. Of the 13 COSMIN measurement properties, studies of GRASSP covered seven, AuSpinal covered five and both SHFT and TRI-HFT covered three properties. CONCLUSIONS The psychometric properties of GRASSP were most extensively studied showing eligible reliability and validity. Although there are still some measurement properties to be explored, GRASSP can be recommended for use in the evaluation of upper extremity mobility in the SCI rehabilitation and research. More research is needed on the psychometrics of other outcome measures in people with spinal cord injuries before the outcome measures can be unconditionally recommended.
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Affiliation(s)
- Joonas Poutanen
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Sarianna Savolainen
- BioMag Laboratory, Helsinki University Hospital, Helsinki, Finland
- Validia Ltd., Helsinki, Finland
| | - Anastasia Shulga
- BioMag Laboratory, Helsinki University Hospital, Helsinki, Finland
- Department of Physical and Rehabilitation Medicine, Helsinki University Hospital, Helsinki, Finland
- Department of Surgery, University of Helsinki, Helsinki, Finland
| | - Jari Arokoski
- Department of Physical and Rehabilitation Medicine, Helsinki University Hospital, Helsinki, Finland
- Clinical Neurosciences, Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Sinikka Hiekkala
- Validia Ltd., Helsinki, Finland
- The Finnish Association of People with Physical Disabilities, Helsinki, Finland
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2
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Oh J, Scheffler MS, Martin CA, Dinh J, Sheynin J, Steele AG, Sayenko DG. Characterizing neurological status in individuals with tetraplegia using transcutaneous spinal stimulation. Sci Rep 2023; 13:21522. [PMID: 38057398 PMCID: PMC10700352 DOI: 10.1038/s41598-023-48811-0] [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: 07/27/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023] Open
Abstract
Transcutaneous spinal stimulation (TSS) is emerging as a valuable tool for electrophysiological and clinical assessment. This study had the objective of examining the recruitment patterns of upper limb (UL) motor pools through the delivery of TSS above and below a spinal lesion. It also aimed to explore the connection between the recruitment pattern of UL motor pools and the neurological and functional status following spinal cord injury (SCI). In eight participants with tetraplegia due to cervical SCI, TSS was delivered to the cervical spinal cord between the spinous processes of C3-C4 and C7-T1 vertebrae, and spinally evoked motor potentials in UL muscles were characterized. We found that responses observed in UL muscles innervated by motor pools below the level of injury demonstrated relatively reduced sensitivity to TSS compared to those above the lesion, were asymmetrical in the majority of muscles, and were dependent on the level, extent, and side of SCI. Overall, our findings indicate that electrophysiological data acquired through TSS can offer insights into the extent of UL functional asymmetry, disruptions in neural pathways, and changes in motor control following SCI. This study suggests that such electrophysiological data can supplement clinical and functional assessment and provide further insight regarding residual motor function in individuals with SCI.
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Affiliation(s)
- Jeonghoon Oh
- Department of Neurosurgery, Center for Translational Neural Prosthetics and Interfaces, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, 77030, USA
| | - Michelle S Scheffler
- Department of Neurosurgery, Center for Translational Neural Prosthetics and Interfaces, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, 77030, USA
| | - Catherine A Martin
- Department of Neurosurgery, Center for Translational Neural Prosthetics and Interfaces, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, 77030, USA
| | - Jenny Dinh
- Department of Neurosurgery, Center for Translational Neural Prosthetics and Interfaces, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, 77030, USA
| | - Jony Sheynin
- Department of Psychiatry and Behavioral Science, Texas A&M University Health Science Center, Houston, TX, USA
| | - Alexander G Steele
- Department of Neurosurgery, Center for Translational Neural Prosthetics and Interfaces, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, 77030, USA
| | - Dimitry G Sayenko
- Department of Neurosurgery, Center for Translational Neural Prosthetics and Interfaces, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, 77030, USA.
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3
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Oh J, Scheffler MS, Martin CA, Dinh J, Sheynin J, Steele AG, Sayenko DG. Transcutaneous spinal stimulation provides characterization of neurological status in individuals with tetraplegia. RESEARCH SQUARE 2023:rs.3.rs-3513515. [PMID: 37986790 PMCID: PMC10659561 DOI: 10.21203/rs.3.rs-3513515/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Transcutaneous spinal stimulation (TSS) is emerging as a valuable tool for electrophysiological and clinical assessment. This study had the objective of examining the recruitment patterns of upper limb (UL) motor pools through the delivery of TSS above and below a spinal lesion. It also aimed to explore the connection between the recruitment pattern of UL motor pools and the neurological and functional status following spinal cord injury (SCI). In eight participants with tetraplegia due to cervical SCI, TSS was delivered to the cervical spinal cord between the spinous processes of C3-C4 and C7-T1 vertebrae, and spinally evoked motor potentials in UL muscles were characterized. We found that responses observed in UL muscles innervated by motor pools below the level of injury demonstrated relatively reduced sensitivity to TSS compared to those above the lesion, were asymmetrical in the majority of muscles, and were dependent on the level, extent, and side of SCI. Overall, our findings indicate that electrophysiological data acquired through TSS can offer insights into the extent of UL functional asymmetry, disruptions in neural pathways, and changes in motor control following SCI. This study suggests that such electrophysiological data can supplement clinical and functional assessment and provide further insight regarding residual motor function in individuals with SCI.
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4
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Han S, Kim W, Kim O. Risk Factors for Suicidality in Individuals With Spinal Cord Injury: A Focus on Physical and Functional Characteristics. Ann Rehabil Med 2023; 47:377-384. [PMID: 37907229 PMCID: PMC10620485 DOI: 10.5535/arm.23110] [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: 07/27/2023] [Revised: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVE : To demonstrate the association between the physical and functional characteristics of individuals with spinal cord injury (SCI) and suicidality, an area of research that is less understood than the association with demographic, social, and psychological characteristics. METHODS : A retrospective cross-sectional study was conducted with 259 patients with SCI admitted for rehabilitation at the National Rehabilitation Center, Seoul, between January 2019 and December 2021. Demographic, SCI-related, physical, and functional data were collected from their medical records. Suicide risk was assessed using the Mini International Neuropsychiatric Interview. RESULTS : The 259 participants had an average age of 49.1 years, and 75.7% were male. The analysis revealed a statistically significant negative correlation between age and suicidality. No significant differences were found for sex, education, occupation, or SCI-related factors. Lower upper extremity motor score (UEMS) was significantly associated with higher suicide risk. Regarding functional factors, the inability to perform independent rolling, come to sit, wheelchair propelling, and self-driving were associated with increased suicidality. In the multiple linear regression analysis, lower UEMS, limited shoulder joint motion, upper extremity spasticity, and dependent wheelchair propulsion were predictors of higher suicide risk. CONCLUSION : This study highlights the associations among physical status, functional dependency, and suicide risk in individuals with SCI. These findings emphasize the need to address psychological aspects and physical and functional factors in the management of individuals with SCI who are at a high risk of suicide.
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Affiliation(s)
- Sora Han
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Wooyeung Kim
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Onyoo Kim
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
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5
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Wang XB, Zhou LY, Chen XQ, Li R, Yu BB, Pan MX, Fang L, Li J, Cui XJ, Yao M, Lu X. Neuroprotective effect and possible mechanism of edaravone in rat models of spinal cord injury: a protocol for a systematic review and meta-analysis. Syst Rev 2023; 12:177. [PMID: 37752580 PMCID: PMC10521558 DOI: 10.1186/s13643-023-02306-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/04/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Spinal cord injury (SCI) is one of the most disabling neurological conditions, afflicting thousands of human beings. Edaravone, a well-known reactive oxygen species scavenger, is expanding its new scope in field of SCI. The objective of this systematic review is to determine the neuroprotective effects and discuss the underlying mechanism of edaravone in management of SCI. METHODS The systematic review will include the controlled studies evaluating the neurological roles of edaravone on experiment rat models following SCI. The primary outcome will be the 21-point Basso, Beattie, and Bresnahan locomotor rating scale. The secondary outcomes will include the preservation of white matter areas and malondialdehyde levels. Two researchers will independently search PubMed, Embase, Web of Science, Scopus and Cochrane Library from their inception date. Following study selection, data extraction, and assessment of methodological quality in included studies using the SYRCLE's RoB tool, data from eligible studies will be pooled and analyzed using random-effects models with RevMan 5.3 software. In case of sufficient data, subgroup analyses with respect to species, age, gender, injury characteristics, or administration details will be carried out to explore the factors modifying efficacy of edaravone. For exploring the appropriate dose of edaravone, a network meta-analysis approach will be conducted based on the Bayesian method. Importantly, the proposed mechanisms and changes of related molecules will be also extracted from included studies for comprehensively investigating the mechanisms underlying the neuroprotective effects of edaravone. DISCUSSION In this study, we aim to quantitatively analyze the role of edaravone in locomotor recovery and tissue damage in SCI rat model. The efficacy of edaravone in distinct scenarios will be investigated by subgroup analyses, and we expect to predict the candidate dose that offers a superior treatment effect using network meta-analyses. Moreover, a comprehensive framework regarding the neuroprotective mechanisms behind edaravone will be constructed via a combination of systematic and traditional review. This study will bring implications for future preclinical studies and clinical applications of SCI. Nonetheless, in light of the anticipated limitations in animal experimental design and methodological quality, the results in this review should be interpreted with caution.
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Affiliation(s)
- Xiao-Bo Wang
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Long-Yun Zhou
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Xu-Qing Chen
- Department of Otolaryngology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, Jiangsu, China
| | - Ran Li
- Traditional Chinese Medicine Hospital of LuAn, Luan, 237006, Anhui, China
| | - Bin-Bin Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Meng-Xiao Pan
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Lu Fang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Jian Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Xue-Jun Cui
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Min Yao
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
| | - Xiao Lu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China.
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Voss S, Adighibe A, Sanders E, Aaby D, Kravitt R, Clark G, Breen K, Barry A, Forrest GF, Kirshblum SC, Perez MA, Kalsi-Ryan S, Kocherginsky M, Rymer WZ, Sandhu MS. Development of a Remote Version of the Graded Redefined Assessment of Strength, Sensation, and Prehension (GRASSP): Validity and Reliability. Neurorehabil Neural Repair 2023; 37:83-93. [PMID: 36987396 PMCID: PMC10939131 DOI: 10.1177/15459683231162830] [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] [Indexed: 03/30/2023]
Abstract
BACKGROUND The Graded Redefined Assessment of Strength, Sensation, and Prehension (GRASSP V1.0) was developed in 2010 as a 3-domain assessment for upper extremity function after tetraplegia (domains: Strength, Sensibility, and Prehension). A remote version (rGRASSP) was created in response to the growing needs of the field of Telemedicine. OBJECTIVE The purpose of this study was to assess the psychometric properties of rGRASSP, establishing concurrent validity and inter-rater reliability. METHODS Individuals with tetraplegia (n = 61) completed 2 visits: 1 in-person and 1 remote. The first visit was completed in-person to administer the GRASSP, and the second visit was conducted remotely to administer the rGRASSP. The rGRASSP was scored both by the administrator of the rGRASSP (Examiner 1), and a second assessor (Examiner 2) to establish inter-rater reliability. Agreement between the in-person and remote GRASSP evaluations was assessed using the intraclass correlation coefficient (ICC) and Bland-Altman agreement plots. RESULTS The remote GRASSP demonstrated excellent concurrent validity with the GRASSP (left hand intraclass correlation coefficient (ICC) = .96, right ICC = .96). Concurrent validity for the domains was excellent for strength (left ICC = .96, right ICC = .95), prehension ability (left ICC = .94, right ICC = .95), and prehension performance (left ICC = .92, right ICC = .93), and moderate for sensibility (left ICC = .59, right ICC = .68). Inter-rater reliability for rGRASSP total score was high (ICC = .99), and remained high for all 4 domains. Bland-Altman plots and limits of agreements support these findings. CONCLUSIONS The rGRASSP shows strong concurrent validity and inter-rater reliability, providing a psychometrically sound remote assessment for the upper extremity in individuals with tetraplegia.
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Affiliation(s)
| | | | | | - David Aaby
- Department of Preventative Medicine, Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Gina Clark
- Shirley Ryan Ability Lab, Chicago, IL, USA
| | | | | | - Gail F. Forrest
- Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Steve C. Kirshblum
- Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Monica A. Perez
- Shirley Ryan Ability Lab, Chicago, IL, USA
- Edward Hines Jr. VA Hospital, Hines, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Masha Kocherginsky
- Department of Preventative Medicine, Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - William Zev Rymer
- Shirley Ryan Ability Lab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Milap S. Sandhu
- Shirley Ryan Ability Lab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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7
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Kalsi-Ryan S, Balbinot G, Wang JZ, Abel R, Bolliger M, Curt A, Fehlings MG, Jin D, Verrier M, Velstra IM. Minimal Clinically Important Difference of Graded Redefined Assessment of Strength, Sensibility, and Prehension Version 1 in Acute Cervical Traumatic Spinal Cord Injury. J Neurotrauma 2022; 39:1645-1653. [PMID: 35652348 DOI: 10.1089/neu.2021.0500] [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: 01/06/2023] Open
Abstract
The Graded Redefined Assessment of Strength, Sensibility, and Prehension Version 1 (GRASSP v1) is a validated measure of upper extremity impairment shown to be sensitive and responsive for traumatic cervical spinal cord injury (SCI) in both North American (NA) and European (EU) cohorts. The minimal clinically important difference (MCID) is the quantitative change in an assessment scale that patients perceive as being beneficial. Our aim was to establish the MCID of all subtests of the GRASSP v1 for cervical SCI. We prospectively analyzed 127 patients from NA and EU for up to six months after motor complete and incomplete cervical SCI using the GRASSP v1, Spinal Cord Independence Measure, and International Standards of Neurological Classification of Spinal Cord Injury. We used a patient global rating of change and the anchor-based method to calculate MCID of GRASSP v1 at six months post-injury. The MCID was established for the whole group, dividing the sample by "better" and "much better." Improvement in GRASSP v1 Strength and Prehension Performance scores of 13 and 3 are the MCID for the better category, and 19 and 7 are the MCID for the much better category, respectively. The MCID was also established for the motor complete and incomplete groups. Improvement in GRASSP v1 Strength and Prehension Performance scores of 12 and 6 are the MCID for the motor complete group, and 17 and 12 are the MCID for the motor incomplete group, respectively. The GRASSP v1 Strength subscore is the most sensitive for detecting meaningful clinical change in patients and is most closely related to measures of independence. Thus, use of GRASSP v1 Strength and Prehension Performance as measures of change is substantiated by this study.
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Affiliation(s)
- Sukhvinder Kalsi-Ryan
- Toronto Rehabilitation Institute-UHN, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Department of Physical Therapy, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, Toronto, Ontario, Canada
| | | | - Justin Zhang Wang
- University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, Toronto, Ontario, Canada
| | - Rainer Abel
- Spinal Cord Injury Centre, Hohe Warte, Bayreuth, Germany.,European Multicenter Study about Human Spinal Cord Injury, Zurich, Switzerland
| | - Marc Bolliger
- Spinal Cord Injury Centre, University Hospital Balgrist, Zurich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Centre, University Hospital Balgrist, Zurich, Switzerland
| | - Michael G Fehlings
- University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, Toronto, Ontario, Canada.,Krembil Neuroscience Centre, Toronto, Ontario, Canada
| | - Daniel Jin
- Toronto Rehabilitation Institute-UHN, Toronto, Ontario, Canada.,University of Waterloo, Waterloo, Ontario, Canada
| | - Mary Verrier
- Toronto Rehabilitation Institute-UHN, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Department of Physical Therapy, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, Toronto, Ontario, Canada
| | - Inge-Marie Velstra
- European Multicenter Study about Human Spinal Cord Injury, Zurich, Switzerland.,Swiss Paraplegic Centre, Knotwil, Switzerland
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Perret C, De Jaegher J, Velstra IM. Feasibility of an Upper Limb Strength Training Program in Persons with Spinal Cord Injury during Primary Rehabilitation-An Uncontrolled Interventional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14743. [PMID: 36429462 PMCID: PMC9690379 DOI: 10.3390/ijerph192214743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
Data concerning the outcomes of standardized strength-training programs in people with acute spinal cord injury (SCI) are scarce. The present study evaluated the feasibility and effects of a clinic-internal strength-training concept in people with paraplegia during the course of primary rehabilitation. For this purpose, participants followed a 10-12 week standardized supervised strength-training program (30 training sessions) during primary rehabilitation. At the beginning, 5-6 weeks and 10-12 weeks later, maximal strength based on indirect one-repetition maximum (1RM) measurements for two specific exercises (triceps press; horizontal rowing pull) was determined. Twelve out of 17 participants successfully completed the study. Maximal weights for 1RM significantly increased over the 10-12 week training program for the triceps press (+30%; p = 0.018) and the horizontal rowing pull (+41%; p = 0.008). Training compliance was 95%. Reasons for study exclusion were urgent surgery (n = 2), cardio-respiratory complications (n = 1), shoulder pain (n = 1) and a training compliance of less than 50% (n = 1). In conclusion, a supervised and standardized strength-training program during primary rehabilitation of people with paraplegia is feasible and leads to significant increases in maximal strength. Although study participants showed a high training compliance, factors such as medical complications may impede the proper implementation of a strength-training concept into daily clinical practice.
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Affiliation(s)
- Claudio Perret
- Sports Medicine, Swiss Paraplegic Centre, 6207 Nottwil, Switzerland
| | - Jolien De Jaegher
- Ambulatory Physiotherapy, Swiss Paraplegic Centre, 6207 Nottwil, Switzerland
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9
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Sacco C, Olivi S, Visani J, Donati R, Veronesi V, Mencarani C, Capone C, Bizzocchi G, Kiekens C, De Bonis P, Scerrati A, Staffa G. Functional outcome after transfer of brachialis on anterior interosseous and supinator on posterior interosseous nerves: A preliminary report. Microsurgery 2022; 42:577-585. [PMID: 35484858 DOI: 10.1002/micr.30891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 02/13/2022] [Accepted: 04/14/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Traumatic spinal cord injury (SCI) resulting in tetraplegia is a leading cause of morbidity among young adults worldwide and its management remains challenging. Restoring hand function in these patients must be considered a top priority with great impact on their quality of life (QOL); although nerve and tendon transfer have been extensively described, type of procedure to be chosen is not standardized and few studies have determined the functional outcome of those procedure and their impact on QOL is still poorly assessed. We report a preliminary retrospective study regarding feasibility and functional outcomes of nerve transfer procedures including bilateral brachialis nerve on anterior interosseous nerve (AIN) and supinator branch on posterior interosseous nerve (PIN) for hand reanimation following SCI focusing on the impact of these procedures on QOL. METHODS We performed a retrospective study involving patient sustained SCI and underwent nerve transfer of brachialis branch from musculocutaneous nerve on AIN and supinator branch from the trunk of the radial nerve on the PIN. We included 11 patients (14 limbs) with traumatic SCI resulting in C4 level tetraplegia in five patients, C5 in four and C6 and C7 in one case each, with a median age of 31.5 years underwent surgery at a median of 10 months after injury; including both transfers in 10 cases and AIN reanimation only in one. Functional assessment including medical research council (MCR) grade, graded redefined assessment of strength sensation and prehension (GRASSP) and spinal cord independence measure (SCIM) were performed at least 12 months follow up. RESULTS Thirteen PIN innervated muscles achieved an MRC score ≥3/5 whereas AIN supplied muscles in 5 out of 15. GRASSP qualitative measure improved from a baseline value of 1 to 2, while quantitative measure passed from 1 to 3 after 12 months; the difference was statistically significant (p = .005 and p = .008, respectively). SCIM self-care sub-score also statistically significant improved from 3 to 4 at 12 months (p = .016). No complication or donor morbidity occurred. CONCLUSIONS Functional performance has been significantly improved by nerve transfer procedures 1 year after surgery. Nerve transfers may represent a valuable option for the restoration of the hand function in patients with tetraplegia with minor or no morbidity.
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Affiliation(s)
- Carlo Sacco
- Peripheral Nerve Surgery Unit, Ospedale per gli Infermi-Faenza, Faenza, Italy
| | - Silvia Olivi
- Spinal Unit, Montecatone Rehabilitation Institute, Imola, Italy
| | - Jacopo Visani
- Peripheral Nerve Surgery Unit, Ospedale per gli Infermi-Faenza, Faenza, Italy.,Department of Neurosurgery, Sant'Anna University Hospital-Ferrara, Cona, Italy
| | - Roberto Donati
- Peripheral Nerve Surgery Unit, Ospedale per gli Infermi-Faenza, Faenza, Italy
| | - Vanni Veronesi
- Peripheral Nerve Surgery Unit, Ospedale per gli Infermi-Faenza, Faenza, Italy
| | - Camilla Mencarani
- Peripheral Nerve Surgery Unit, Ospedale per gli Infermi-Faenza, Faenza, Italy
| | - Crescenzo Capone
- Peripheral Nerve Surgery Unit, Ospedale per gli Infermi-Faenza, Faenza, Italy
| | - Gianluca Bizzocchi
- Peripheral Nerve Surgery Unit, Ospedale per gli Infermi-Faenza, Faenza, Italy
| | | | - Pasquale De Bonis
- Department of Neurosurgery, Sant'Anna University Hospital-Ferrara, Cona, Italy
| | - Alba Scerrati
- Department of Neurosurgery, Sant'Anna University Hospital-Ferrara, Cona, Italy
| | - Guido Staffa
- Peripheral Nerve Surgery Unit, Ospedale per gli Infermi-Faenza, Faenza, Italy
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10
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Differences in sensorimotor and functional recovery between the dominant and non-dominant upper extremity following cervical spinal cord injury. Spinal Cord 2022; 60:422-427. [PMID: 35273373 DOI: 10.1038/s41393-022-00782-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 02/18/2022] [Accepted: 02/20/2022] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Post hoc analysis of prospective multi-national, multi-centre cohort study. OBJECTIVE Determine whether cerebral dominance influences upper extremity recovery following cervical spinal cord injury (SCI). SETTING A multi-national subset of the longitudinal GRASSP dataset (n = 127). METHODS Secondary analysis of prospective, longitudinal multicenter study of individuals with cervical SCI (n = 73). Study participants were followed for up to 12 months after a cervical SCI, and the following outcome measures were serially assessed - the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP) and the International Standards for the Neurological Classification of SCI (ISNCSCI), including upper extremity motor and sensory scores. Observed recovery and relative (percent) recovery were then determined for both the GRASSP and ISNCSCI, based on change from initial to last available assessment. RESULTS With the exception of prehension performance (quantitative grasping) following complete cervical SCI, there were no significant differences (p < 0.05) for observed and relative (percent) recovery, between the dominant and non-dominant upper extremities, as measured using GRASSP subtests, ISNCSCI motor scores and ISNCSCI sensory scores. CONCLUSION Despite well documented differences between the cerebral hemispheres, cerebral dominance appears to play a limited role in upper extremity recovery following acute cervical SCI.
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11
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Kapadia N, Jovanovic L, Musselman K, Wang R, Marquez-Chin C, Popovic MR. Preliminary evaluation of the reliability and validity of the 3D printed Toronto Rehabilitation Institute-Hand Function Test in individuals with spinal cord injury. J Spinal Cord Med 2021; 44:S225-S233. [PMID: 34779739 PMCID: PMC8604468 DOI: 10.1080/10790268.2021.1961055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The study objectives were to evaluate the inter-rater and intra-rater reliability; and criterion and construct validity of the 3D printed Toronto Rehabilitation Institute -Hand Function Test (3D TRI-HFT) in individuals with spinal cord injury (SCI). DESIGN Observational study. SETTING Inpatient Rehabilitation Hospital. PARTICIPANTS Four individuals with subacute and three individuals with chronic SCI. INTERVENTIONS Reliability and validity of the 3D TRI-HFT was assessed within two interventional studies. OUTCOME MEASURES Participants performed the 3D TRI-HFT, Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP), Functional Independence Measure (FIM) and the Spinal Cord Independence Measure (SCIM) at baseline, after 20 and 40 sessions of therapy and at six month follow-up from baseline. 3D TRI-HFT assessments were graded at the time of performance and re-graded from the video recordings for purpose of reliability testing. Validity testing was done by comparing the scores on 3D TRI-HFT with the scores on the GRASSP, and the FIM and SCIM self care sub-scores. RESULTS The 3D TRI-HFT had high intra-rater and inter-rater reliability in sub-acute and chronic SCI with ICC values exceeding 0.99. Moderate to strong correlations were found between 3D TRI-HFT object manipulation scores and the FIM and SCIM self care sub-scores, with r values in the range of 0.7-0.8. Strong correlations were found between the various components of GRASSP and the 3D TRI-HFT, with r values exceeding 0.9. CONCLUSIONS The 3D TRI-HFT is a reliable and valid measure to assess unilateral hand gross motor function in individuals with SCI.
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Affiliation(s)
- Naaz Kapadia
- KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, Canada,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada,CRANIA, University Health Network and University of Toronto, Toronto, Canada,Correspondence to: Naaz Kapadia, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada; The KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada; Rocket Family Upper Extremity Clinic, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada, 550 University Avenue, Toronto, ONM5G 2A2, Canada; Ph: 416-597-3422 Ext: 7949. ; https://www.linkedin.com/in/naaz-desai-97099230/
| | - Lazar Jovanovic
- KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, Canada,Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Kristin Musselman
- KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, Canada,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada,CRANIA, University Health Network and University of Toronto, Toronto, Canada,Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Rosalie Wang
- KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, Canada,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada,Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
| | - Cesar Marquez-Chin
- KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, Canada,CRANIA, University Health Network and University of Toronto, Toronto, Canada,Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Milos R. Popovic
- KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, Canada,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada,CRANIA, University Health Network and University of Toronto, Toronto, Canada,Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
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Kalsi-Ryan S, Kapadia N, Gagnon DH, Verrier MC, Holmes J, Flett H, Farahani F, Alavinia SM, Omidvar M, Wiest MJ, Craven BC. Development of Reaching, Grasping & Manipulation indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project. J Spinal Cord Med 2021; 44:S134-S146. [PMID: 34779738 PMCID: PMC8604521 DOI: 10.1080/10790268.2021.1961052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To describe the development of structure, process, and outcome indicators aimed to advance the quality of Reaching, Grasping & Manipulation (RG&M) rehabilitation for Canadians living with spinal cord injury or disease (SCI/D). METHOD Upper extremity rehabilitation experts developed a framework of indicators for evaluation of RG&M rehabilitation quality. A systematic search of the literature identified potential upper extremity indicators that influence RG&M outcomes. A Driver diagram summarized factors influencing upper extremity outcomes to inform the selection of structure and process indicators. Psychometric properties, clinical utility, and feasibility of potential upper extremity measures were considered when selecting outcome indicators. RESULTS The selected structure indicator is the number of occupational and physical therapists with specialized certification, education, training and/or work experience in upper extremity therapy related to RG&M at a given SCI/D rehabilitation center. The process indicator is the total hours of upper extremity therapies related to RG&M and the proportion of this time allocated to neurorestorative therapy for each individual with tetraplegia receiving therapy. The outcome indicators are the Graded Redefined Assessment of Strength, Sensation and Prehension (GRASSP) strength and Spinal Cord Independence Measure III (SCIM III) Self-Care subscores implemented at rehabilitation admission and discharge, and SCIM III Self-Care subscore only at 18 months post-admission. CONCLUSION The selected indicators align with current practice, will direct the timing of routine assessments, and enhance the volume and quality of RG&M therapy delivered, with the aim to ultimately increase the proportion of individuals with tetraplegia achieving improved upper extremity function by 18 months post-rehabilitation.
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Affiliation(s)
- Sukhvinder Kalsi-Ryan
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Rocket Family Upper Extremity Clinic, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
| | - Naaz Kapadia
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Rocket Family Upper Extremity Clinic, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- CRANIA, University Health Network and University of Toronto, Toronto, Canada
| | - Dany H. Gagnon
- School of Rehabilitation, Université de Montréal, Montreal, Québec, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain - CIUSSS du Centre-Sud-de-l’Ile-de-Montréal, Montreal, Québec, Canada
| | - Molly C. Verrier
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Holmes
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Heather Flett
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Farnoosh Farahani
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - S. Mohammad Alavinia
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Maryam Omidvar
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Matheus J. Wiest
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Ontario Neurotrauma Foundation, Toronto, Ontario, Canada
| | - B. Catharine Craven
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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13
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Freund P, Seif M, Weiskopf N, Friston K, Fehlings MG, Thompson AJ, Curt A. MRI in traumatic spinal cord injury: from clinical assessment to neuroimaging biomarkers. Lancet Neurol 2019; 18:1123-1135. [DOI: 10.1016/s1474-4422(19)30138-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 03/22/2019] [Accepted: 03/28/2019] [Indexed: 01/18/2023]
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14
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Kalsi-Ryan S, Chan C, Verrier M, Curt A, Fehlings M, Bolliger M, Velstra IM. The graded redefined assessment of strength sensibility and prehension version 2 (GV2): Psychometric properties. J Spinal Cord Med 2019; 42:149-157. [PMID: 31573454 PMCID: PMC6781465 DOI: 10.1080/10790268.2019.1616950] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Context: GRASSP Version 1 (GV1) was developed in 2010, is an upper extremity measure specifically designed to assess recovery after traumatic tetraplegia. A second version was developed to reduce length of the test and refine instructions/standardization. The purpose of this post hoc analysis was to calculate psychometric properties of GRASSP Version 2 (GV2). Design/Setting: A post-hoc analysis of datasets for the GRASSP cross-sectional (n = 72 chronic,) and longitudinal (n = 127 acute) studies was conducted. Reliability, validity and MDD were calculated from the chronic sample and responsiveness was re-calculated from the longitudinal sample. Both studies were observational. Participants: A chronic sample (n = 72) and acute longitudinal sample (n = 127) of individuals with traumatic tetraplegia (AIS A to D, NLI C2 to C8) were studied. Outcome Measures: GV1, the Spinal Cord Independence Measure III (SCIM), International Standards of Neurological Classification of Spinal Cord Injury (ISNCSCI) were administered in both studies at all centers and the Capabilities of the Upper Extremity Questionnaire (CUE-Q) was administered in North American sites only. GRASSP-Palmar Sensation, GRASSP-Prehension Performance subtest items included in GV2 were re-analyzed for reliability; validity, MDD and responsiveness. Results: Inter-rater and test-retest reliability for all subtests ranged between 0.849-0.971 and 0.950-0.971 respectively. Concurrent validity between domains of GV2 were positively and moderately (0.530-0.830, P < 0.0001) correlated to SCIM, SCIM self-care subscore (SS) and CUE-Q. MDD values were 4 and 3 points for sensation and prehension performance (single side). Responsiveness values were .84-.88 for GR-Sens and .93-1.22 for GR-PP respectively. Conclusions: GV2 retains excellent psychometric properties as does GV1.
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Affiliation(s)
- Sukhvinder Kalsi-Ryan
- KITE, Toronto Rehabilitation Institute-UHN, Toronto, Canada,Departtment of Physical Therapy, University of Toronto, Toronto, Canada,Correspondence to: Sukhvinder Kalsi-Ryan, Toronto Rehabilitation Institute, 520 Sutherland Drive, Rehabilitation Engineering Lab-REL, Toronto, Ontario M4G 3V9, Canada.
| | - Colin Chan
- Biomedical Engineering, University of Western Ontario, London, Canada
| | - Mary Verrier
- KITE, Toronto Rehabilitation Institute-UHN, Toronto, Canada,Departtment of Physical Therapy, University of Toronto, Toronto, Canada,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Armin Curt
- Spinal Cord Injury Centre, University Hospital Balgrist, Zurich, Switzerland
| | - Michael Fehlings
- Department of Surgery, University of Toronto, Toronto, Canada,Krembil Neuroscience Centre, University Health Network, Toronto, Canada
| | - Marc Bolliger
- Spinal Cord Injury Centre, University Hospital Balgrist, Zurich, Switzerland
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15
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Tomaschek R, Gemperli A, Rupp R, Geng V, Scheel-Sailer A. A systematic review of outcome measures in initial rehabilitation of individuals with newly acquired spinal cord injury: providing evidence for clinical practice guidelines. Eur J Phys Rehabil Med 2019; 55:605-617. [DOI: 10.23736/s1973-9087.19.05676-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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16
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Schneider S, Popp WL, Brogioli M, Albisser U, Ortmann S, Velstra IM, Demko L, Gassert R, Curt A. Predicting upper limb compensation during prehension tasks in tetraplegic spinal cord injured patients using a single wearable sensor. IEEE Int Conf Rehabil Robot 2019; 2019:1000-1006. [PMID: 31374760 DOI: 10.1109/icorr.2019.8779561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Upper limb (UL) compensation is a common strategy of patients with a high spinal cord injury (SCI), i.e., tetraplegic patients, to perform activities of daily living (ADLs) despite their sensorimotor deficits. Currently, an objective and sensitive tool to assess UL compensation, which is applicable in the clinical routine and in the daily life of patients, is missing. In this work, we propose a metric to quantify this compensation using a single inertial measurement unit (IMU). The spread of forearm pitch angles of an IMU attached to the wrist of 17 SCI patients and 18 healthy controls performing six prehension tasks of the graded redefined assessment of strength, sensibility and prehension (GRASSP) was extracted. Using the spread of the forearm pitch angles, a classification of UL compensation was possible with very good to excellent accuracies in all six different prehension tasks. Furthermore, the spread of forearm pitch angles correlated moderately to very strongly with qualitative and quantitative GRASSP prehension scores and the task duration. Therefore, we conclude that our proposed method has a high potential to classify compensation accurately and objectively and might be used to quantify the degree of UL compensation in ADLs. Thus, this method could be implemented in clinical trials investigating the effectiveness of interventions targeting UL functions.
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17
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Marino RJ, Sinko R, Bryden A, Backus D, Chen D, Nemunaitis GA, Leiby BE. Comparison of Responsiveness and Minimal Clinically Important Difference of the Capabilities of Upper Extremity Test (CUE-T) and the Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP). Top Spinal Cord Inj Rehabil 2018; 24:227-238. [PMID: 29997426 DOI: 10.1310/sci2403-227] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background: The Capabilities of Upper Extremity Test (CUE-T) and the Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP) were both developed to detect change in upper extremity (UE) function in persons with tetraplegia. Objective: To compare the responsiveness and minimal clinically important difference (MCID) of the CUE-T and the quantitative prehension (QtP) scale of the GRASSP. Methods: Subjects included 69 persons with tetraplegia: 60 with acute and 9 with chronic injuries. Subjects were assessed twice 3 months apart using the CUE-T, QtP-GRASSP, and upper extremity motor scores (UEMS). Subjects rated their impression of change in overall and right/left UE function from -7 to +7. The standardized response mean (SRM) was determined for acute subjects. MCID was estimated using a small subjective change (2-3 points) and change in UEMS. Results: Subjects were 41.9 ± 18.1 years old, neurological levels C1-C7; 25 were motor complete. For acute subjects, the SRMs for total/side CUE-T scores were 1.07/0.96, and for the QtP-GRASSP they were 0.88/0.78. MCIDs based on subjective change for total/side CUE-T scores were 11.7/6.1 points and for QtP-GRASSP were 6.4/3.0 points. Based on change in UEMS, MCIDs for total/side were 11.9/6.3 points for CUE-T and 6.0/3.3 points for QtP-GRASSP. Some subjects had changes in the CUE-T due to its arm items that were not seen with the QtP-GRASSP. Conclusion: Both the CUE-T and QtP-GRASSP are responsive to change in persons with acute cervical spinal cord injury with large SRMs. The CUE-T detects some changes in UE function not seen with the QtP-GRASSP.
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Affiliation(s)
- Ralph J Marino
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College, Jefferson (Philadelphia University + Thomas Jefferson University), Philadelphia, Pennsylvania
| | - Rebecca Sinko
- Department of Occupational Therapy, Jefferson College of Health Professions, Jefferson (Philadelphia University + Thomas Jefferson University), Philadelphia, Pennsylvania
| | - Anne Bryden
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Deborah Backus
- Crawford Research Institute, Shepherd Center Hospital, Atlanta, Georgia
| | - David Chen
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois
| | - Gregory A Nemunaitis
- MetroHealth Medical Center/MetroHealth Rehabilitation Institute of Ohio, Cleveland, Ohio.,Department of Physical Medicine & Rehabilitation, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Benjamin E Leiby
- Division of Biostatics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College at, Jefferson (Philadelphia University + Thomas Jefferson University), Philadelphia, Pennsylvania
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18
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Dent K, Grampurohit N, Thielen CC, Sadowsky C, Davidson L, Taylor HB, Bultman J, Gaughan J, Marino RJ, Mulcahey MJ. Evaluation of the Capabilities of Upper Extremity Test (CUE-T) in Children With Tetraplegia. Top Spinal Cord Inj Rehabil 2018; 24:239-251. [PMID: 29997427 DOI: 10.1310/sci2403-239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: The Capabilities of Upper Extremity Test (CUE-T) is a spinal cord injury (SCI)-specific instrument based on the CUE Questionnaire (CUE-Q). Objective: To evaluate the psychometric properties of CUE-T in children with cervical SCI and determine the lowest age appropriate for test administration. Method: In this repeated measures multicenter study, 39 youths, mean age 12.3 years and mean time post injury 5.14 years, completed two administrations of the CUE-T. Test-retest reliability, internal consistency, and known groups validity were measured. Concurrent and discriminant validity were measured against previously validated measures: CUE-Q, Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP), Spinal Cord Independence Measure (SCIM) III, SCIM III-Self Care (SCIM-SC), and SCIM-Mobility. Results: The CUE-T scores demonstrated strong test-retest reliability (ICC ≥ 0.95), strong internal consistency (α ≥ 0.90), and acceptable individual item agreement (κ ≥ 0.49). The hand subscale had better scores (p < .05) for the motor incomplete versus complete known groups, and the arm, hand, and side subscales had better scores (p < .05) for higher versus lower strength groups. The CUE-T had strong concurrent validity with the CUE-Q (r = 0.85-0.87), GRASSP (r = 0.78-0.90), and SCIM-SC (r = 0.70) and moderate-to-weak correlation with the total SCIM (r = 0.65) and SCIM-Mobility (r = 0.51). Children older than 6 years with mature grasp patterns were able to complete the CUE-T. Conclusion: The CUE-T scores are reliable and valid for use in children with cervical SCI older than 6 years of age.
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Affiliation(s)
- Kathryn Dent
- Department of Occupational Therapy, Jefferson College of Health Professions, Jefferson (Philadelphia University + Thomas Jefferson University), Philadelphia, Pennsylvania
| | - Namrata Grampurohit
- Department of Occupational Therapy, Jefferson College of Health Professions, Jefferson (Philadelphia University + Thomas Jefferson University), Philadelphia, Pennsylvania
| | - Christina Calhoun Thielen
- Department of Occupational Therapy, Jefferson College of Health Professions, Jefferson (Philadelphia University + Thomas Jefferson University), Philadelphia, Pennsylvania
| | | | | | | | - Jackie Bultman
- Mary Free Bed Rehabilitation Hospital, Grand Rapids, Michigan
| | - John Gaughan
- Department of Occupational Therapy, Jefferson College of Health Professions, Jefferson (Philadelphia University + Thomas Jefferson University), Philadelphia, Pennsylvania
| | - Ralph J Marino
- Department of Occupational Therapy, Jefferson College of Health Professions, Jefferson (Philadelphia University + Thomas Jefferson University), Philadelphia, Pennsylvania
| | - M J Mulcahey
- Department of Occupational Therapy, Jefferson College of Health Professions, Jefferson (Philadelphia University + Thomas Jefferson University), Philadelphia, Pennsylvania.,Shriners Hospitals for Children, Philadelphia, Pennsylvania
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19
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Levi AD, Anderson KD, Okonkwo DO, Park P, Bryce TN, Kurpad SN, Aarabi B, Hsieh J, Gant K. Clinical Outcomes from a Multi-Center Study of Human Neural Stem Cell Transplantation in Chronic Cervical Spinal Cord Injury. J Neurotrauma 2018; 36:891-902. [PMID: 30180779 DOI: 10.1089/neu.2018.5843] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Human neural stem cell transplantation (HuCNS-SC®) is a promising central nervous system (CNS) tissue repair strategy in patients with stable neurological deficits from chronic spinal cord injury (SCI). These immature human neural cells have been demonstrated to survive when transplanted in vivo, extend neural processes, form synaptic contacts, and improve functional outcomes after experimental SCI. A phase II single blind, randomized proof-of-concept study of the safety and efficacy of HuCNS-SC transplantation into the cervical spinal cord was undertaken in patients with chronic C5-7 tetraplegia, 4-24 months post-injury. In Cohort I (n = 6) dose escalation from 15,000,000 to 40,000,000 cells was performed to determine the optimum dose. In Cohort II an additional six participants were transplanted at target dose (40,000,000) and compared with four untreated controls. Within the transplant group, there were nine American Spinal Injury Association Impairment Scale (AIS) B and three AIS A participants with a median age at transplant of 28 years with an average time to transplant post-injury of 1 year. Immunosuppression was continued for 6 months post-transplant, and immunosuppressive blood levels of tacrolimus were achieved and well tolerated. At 1 year post-transplantation, there was no evidence of additional spinal cord damage, new lesions, or syrinx formation on magnetic resonance (MR) imaging. In summary, the incremental dose escalation design established surgical safety, tolerability, and feasibility in Cohort I. Interim analysis of Cohorts I and II demonstrated a trend toward Upper Extremity Motor Score (UEMS) and Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP) motor gains in the treated participants, but at a magnitude below the required clinical efficacy threshold set by the sponsor to support further development resulting in early study termination.
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Affiliation(s)
- Allan D Levi
- 1 Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
| | - Kim D Anderson
- 1 Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
| | - David O Okonkwo
- 2 Department of Neurosurgery, University of Pittsburgh, Pennsylvania
| | - Paul Park
- 3 Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Thomas N Bryce
- 4 Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Shekar N Kurpad
- 5 Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Bizhan Aarabi
- 6 Department of Neurosurgery, University of Maryland, Baltimore, Maryland
| | | | - Katie Gant
- 1 Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
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20
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Scharfenberger TM, Schrafl-Altermatt M, Dietz V. Cooperative hand movements in tetraplegic spinal cord injury patients: Preserved neural coupling. Clin Neurophysiol 2018; 129:2059-2064. [PMID: 30077074 DOI: 10.1016/j.clinph.2018.06.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/26/2018] [Accepted: 06/29/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To evaluate whether the task-specific neural coupling mechanism during the performance of cooperative hand movements is preserved in tetraplegic subjects. METHODS Recordings of ipsilateral and contralateral electromyographic reflex responses in activated forearm muscles and bilateral somatosensory potentials (SSEP) to unilateral ulnar nerve stimulations during rest, cooperative and non-cooperative hand movements. RESULTS Contralateral reflex responses were present in almost all patients during cooperative hand movements but small in amplitude when hand function was severely impaired. Ipsilateral SSEP potentials were enhanced during both cooperative and, in contrast to healthy subjects, also non-cooperative bimanual movements. CONCLUSIONS Both results indicate a strong involvement of ipsilateral non-damaged cervical tracts and hemispheres in the control of bimanual hand movements in tetraplegic subjects. SIGNIFICANCE This study on the neural control of bimanual movements in patients suffering a cervical injury allows designing therapeutic approaches for the improvement of hand function that are based on physiological insights.
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Affiliation(s)
- T M Scharfenberger
- Spinal Cord Injury Center, University Hospital Balgrist, Zürich, Switzerland.
| | - M Schrafl-Altermatt
- Spinal Cord Injury Center, University Hospital Balgrist, Zürich, Switzerland; Neural Control of Movement Laboratory, ETH Zürich, Switzerland.
| | - V Dietz
- Spinal Cord Injury Center, University Hospital Balgrist, Zürich, Switzerland.
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21
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Evaluation of the graded redefined assessment of strength, sensibility and prehension (GRASSP) in children with tetraplegia. Spinal Cord 2018; 56:741-749. [DOI: 10.1038/s41393-018-0084-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/17/2018] [Indexed: 11/08/2022]
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22
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Velstra IM, Fellinghauer C, Abel R, Kalsi-Ryan S, Rupp R, Curt A. The Graded and Redefined Assessment of Strength, Sensibility, and Prehension Version 2 Provides Interval Measure Properties. J Neurotrauma 2018; 35:854-863. [PMID: 29160145 DOI: 10.1089/neu.2017.5195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Graded and Redefined Assessment of Strength, Sensibility and Prehension (GRASSP) is a valid, reliable, and responsive outcome measure to evaluate upper limb function in individuals with tetraplegia. GRASSP generates ordinal total scores; therefore, applicability as an interval level measurement requires testing of its measurement properties. This study examined the metric characteristics with Rasch Analysis to derive interval level scales of the respective GRASSP subtests. The GRASSP was recorded within 10 days, and at 1, 3, 6, and 12 months after cervical spinal cord injury (SCI). Rasch analysis was performed for each GRASSP subscale to assess the following metric assumptions: absence of local item dependency (LID), unidimensionality, monotonicity, item and model fit, reliability, and absence of differential item functioning (DIF) for side (left and right) and examination stage. If these assumptions could not be met, adjustments were undertaken to achieve a good fit to the Rasch model. Seventy-seven individuals with cervical SCI were included (n = 154 arms). Stacking the data for the side (left and right) resulted in a total of 614 observations, which were based on the repeated measurements. With minor adjustments, the GRASSP subscales showed good reliability, item fit, and ordered response options. Local item dependencies were found in the strength and sensibility subscales. Redundancies among some measurement items allowed shortening of the subscales without reasonable loss of reliability. Absence of DIF for the examination stage supported robustness of the subscales over time. The modified GRASSP, now Version 2, subtest scores can be applied as interval level measurements, and the reduction of items within subscales allows for shorter assessment times in clinical studies without degrading metric properties.
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Affiliation(s)
| | - Carolina Fellinghauer
- 2 Swiss Paraplegic Research (SPF), ICF Unit , Nottwil, Switzerland .,3 Department of Health Sciences and Health Policy, University of Lucerne , Lucerne, Switzerland
| | - Rainer Abel
- 4 Spinal Cord Injury Center , Hohe Warte, Bayreuth, Germany
| | - Sukhvinder Kalsi-Ryan
- 5 Toronto Rehabilitation Institute, University Health Network , Toronto, Ontario, Canada .,6 Department of Physical Therapy , University of Toronto , Toronto, Ontario, Canada
| | - Rüdiger Rupp
- 7 Klinik für Paraplegiologie, Universitätsklinikum Heidelberg , Heidelberg, Germany
| | - Armin Curt
- 8 Spinal Cord Injury Center, Balgrist University Hospital , Zurich, Switzerland
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Fehlings MG, Kim KD, Aarabi B, Rizzo M, Bond LM, McKerracher L, Vaccaro AR, Okonkwo DO. Rho Inhibitor VX-210 in Acute Traumatic Subaxial Cervical Spinal Cord Injury: Design of the SPinal Cord Injury Rho INhibition InvestiGation (SPRING) Clinical Trial. J Neurotrauma 2018; 35:1049-1056. [PMID: 29316845 PMCID: PMC5908415 DOI: 10.1089/neu.2017.5434] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Traumatic spinal cord injury (SCI) is associated with a lifetime of disability stemming from loss of motor, sensory, and autonomic functions; these losses, along with increased comorbid sequelae, negatively impact health outcomes and quality of life. Early decompression surgery post-SCI can enhance patient outcomes, but does not directly facilitate neural repair and regeneration. Currently, there are no U.S. Food and Drug Administration-approved pharmacological therapies to augment motor function and functional recovery in individuals with traumatic SCI. After an SCI, the enzyme, Rho, is activated by growth-inhibitory factors and regulates events that culminate in collapse of the neuronal growth cone, failure of axonal regeneration, and, ultimately, failure of motor and functional recovery. Inhibition of Rho activation is a potential treatment for injuries such as traumatic SCI. VX-210, an investigational agent, inhibits Rho. When administered extradurally after decompression (corpectomy or laminectomy) and stabilization surgery in a phase 1/2a study, VX-210 was well tolerated. Here, we describe the design of the SPRING trial, a multicenter, phase 2b/3, randomized, double-blind, placebo-controlled clinical trial to evaluate the efficacy and safety of VX-210 (NCT02669849). A subset of patients with acute traumatic cervical SCI is currently being enrolled in the United States and Canada. Medical, neurological, and functional changes are evaluated at 6 weeks and at 3, 6, and 12 months after VX-210 administration. Efficacy will be assessed by the primary outcome measure, change in upper extremity motor score at 6 months post-treatment, and by secondary outcomes that include question-based and task-based evaluations of functional recovery.
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Affiliation(s)
- Michael G Fehlings
- 1 Division of Neurosurgery and Spine Program, University of Toronto , Toronto, Ontario, Canada
| | - Kee D Kim
- 2 Department of Neurological Surgery, University of California Davis School of Medicine , Sacramento, California
| | - Bizhan Aarabi
- 3 Department of Neurosurgery, University of Maryland School of Medicine , Baltimore, Maryland
| | - Marco Rizzo
- 4 Vertex Pharmaceuticals Incorporated , Boston, Massachusetts
| | - Lisa M Bond
- 5 BioAxone BioSciences, Inc , Cambridge, Massachusetts
| | | | - Alexander R Vaccaro
- 6 Department of Orthopaedic Surgery, Sidney Kimmel Medical Center at Thomas Jefferson University , Philadelphia, Pennsylvania
| | - David O Okonkwo
- 7 Department of Neurological Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
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24
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Jones LAT, Bryden A, Wheeler TL, Tansey KE, Anderson KD, Beattie MS, Blight A, Curt A, Field-Fote E, Guest JD, Hseih J, Jakeman LB, Kalsi-Ryan S, Krisa L, Lammertse DP, Leiby B, Marino R, Schwab JM, Scivoletto G, Tulsky DS, Wirth E, Zariffa J, Kleitman N, Mulcahey MJ, Steeves JD. Considerations and recommendations for selection and utilization of upper extremity clinical outcome assessments in human spinal cord injury trials. Spinal Cord 2017; 56:414-425. [PMID: 29284795 PMCID: PMC5951792 DOI: 10.1038/s41393-017-0015-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/16/2017] [Accepted: 08/18/2017] [Indexed: 11/21/2022]
Abstract
Study design This is a focused review article. Objectives This review presents important features of clinical outcomes assessments (COAs) in human spinal cord injury research. Considerations for COAs by trial phase and International Classification of Functioning, Disability and Health are presented as well as strengths and recommendations for upper extremity COAs for research. Clinical trial tools and designs to address recruitment challenges are identified. Methods The methods include a summary of topics discussed during a two-day workshop, conceptual discussion of upper extremity COAs and additional focused literature review. Results COAs must be appropriate to trial phase and particularly in mid-late-phase trials, should reflect recovery vs. compensation, as well as being clinically meaningful. The impact and extent of upper vs. lower motoneuron disease should be considered, as this may affect how an individual may respond to a given therapeutic. For trials with broad inclusion criteria, the content of COAs should cover all severities and levels of SCI. Specific measures to assess upper extremity function as well as more comprehensive COAs are under development. In addition to appropriate use of COAs, methods to increase recruitment, such as adaptive trial designs and prognostic modeling to prospectively stratify heterogeneous populations into appropriate cohorts should be considered. Conclusions With an increasing number of clinical trials focusing on improving upper extremity function, it is essential to consider a range of factors when choosing a COA. Sponsors Craig H. Neilsen Foundation, Spinal Cord Outcomes Partnership Endeavor.
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Affiliation(s)
| | - Anne Bryden
- Case Western Reserve University, Cleveland, OH, USA
| | | | - Keith E Tansey
- University of Mississippi Medical Center, Jackson, MS, USA.,Methodist Rehabilitation Center, Jackson, MS, USA.,Veterans Administration Medical Center, Jackson, MS, USA
| | | | | | | | - Armin Curt
- University Hospital Balgrist, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Edelle Field-Fote
- Shepherd Center, Atlanta, GA, USA.,Emory University, Atlanta, GA, USA.,Georgia Institute of Technology, Atlanta, GA, USA
| | | | - Jane Hseih
- Wings for Life, Salzburg, Austria.,Parkwood Institute, London, ON, Canada
| | - Lyn B Jakeman
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Sukhvinder Kalsi-Ryan
- Toronto Rehabilitation Institute, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Laura Krisa
- Thomas Jefferson University, Philadelphia, PA, USA
| | - Daniel P Lammertse
- Craig Hospital, Englewood, CO, USA.,University of Colorado, Aurora, CO, USA
| | | | - Ralph Marino
- Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | | | - Ed Wirth
- Asterias Biotherapeutics, Fremont, CA, USA
| | - José Zariffa
- Toronto Rehabilitation Institute, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
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25
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Brogioli M, Popp WL, Schneider S, Albisser U, Brust AK, Frotzler A, Gassert R, Curt A, Starkey ML. Multi-Day Recordings of Wearable Sensors Are Valid and Sensitive Measures of Function and Independence in Human Spinal Cord Injury. J Neurotrauma 2016; 34:1141-1148. [PMID: 27533063 DOI: 10.1089/neu.2016.4583] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Wearable sensor assessment tools have proven to be reliable in measuring function in normal and impaired movement disorders during well-defined assessment protocols. While such assessments can provide valid and sensitive measures of upper limb activity in spinal cord injury (SCI), no assessment tool has yet been introduced into unsupervised daily recordings to complement clinical assessments during rehabilitation. The objective of this study was to measure the overall amount of upper-limb activity in subjects with acute SCI using wearable sensors and relate this to lesion characteristics, independence, and function. The overall amount of upper extremity activity counts, measures of wheeling (speed and distance), and limb-use laterality were measured in 30 in-patients with an acute cervical or thoracic SCI three months after injury. The findings were related to the international standards for neurological classification of SCI, the spinal cord independence measure, and the upper extremity motor scores of the Graded and Redefined Assessment of Strength, Sensibility, and Prehension. Overall upper extremity activity counts were successfully recorded in all patients and correlated with the neurological level of injury and independence. Clinical measures of proximal muscle strength were related to overall activity count and peak velocity of wheeling. Compared with paraplegics, tetraplegics showed significantly lower activity counts and increased limb-use laterality. This is the first cross-sectional study showing the feasibility and clinical value of sensor recordings during unsupervised daily activities in rehabilitation. The strong relationship between sensor-based measures and clinical outcomes supports the application of such technology to assess and track changes in function during rehabilitation and in clinical trials.
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Affiliation(s)
- Michael Brogioli
- 1 Spinal Cord Injury Center, Balgrist University Hospital , Zurich, Switzerland
| | - Werner L Popp
- 1 Spinal Cord Injury Center, Balgrist University Hospital , Zurich, Switzerland .,2 Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich , Zurich, Switzerland
| | - Sophie Schneider
- 1 Spinal Cord Injury Center, Balgrist University Hospital , Zurich, Switzerland
| | - Urs Albisser
- 1 Spinal Cord Injury Center, Balgrist University Hospital , Zurich, Switzerland
| | - Anne K Brust
- 3 Clinical Trial Unit, Swiss Paraplegic Centre , Nottwil, Switzerland
| | - Angela Frotzler
- 3 Clinical Trial Unit, Swiss Paraplegic Centre , Nottwil, Switzerland
| | - Roger Gassert
- 2 Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich , Zurich, Switzerland
| | - Armin Curt
- 1 Spinal Cord Injury Center, Balgrist University Hospital , Zurich, Switzerland
| | - Michelle L Starkey
- 1 Spinal Cord Injury Center, Balgrist University Hospital , Zurich, Switzerland
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26
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Brogioli M, Schneider S, Popp WL, Albisser U, Brust AK, Velstra IM, Gassert R, Curt A, Starkey ML. Monitoring Upper Limb Recovery after Cervical Spinal Cord Injury: Insights beyond Assessment Scores. Front Neurol 2016; 7:142. [PMID: 27630612 PMCID: PMC5005421 DOI: 10.3389/fneur.2016.00142] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/18/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Preclinical investigations in animal models demonstrate that enhanced upper limb (UL) activity during rehabilitation promotes motor recovery following spinal cord injury (SCI). Despite this, following SCI in humans, no commonly applied training protocols exist, and therefore, activity-based rehabilitative therapies (ABRT) vary in frequency, duration, and intensity. Quantification of UL recovery is limited to subjective questionnaires or scattered measures of muscle function and movement tasks. OBJECTIVE To objectively measure changes in UL activity during acute SCI rehabilitation and to assess the value of wearable sensors as novel measurement tools that are complimentary to standard clinical assessments tools. METHODS The overall amount of UL activity and kinematics of wheeling were measured longitudinally with wearable sensors in 12 thoracic and 19 cervical acute SCI patients (complete and incomplete). The measurements were performed for up to seven consecutive days, and simultaneously, SCI-specific assessments were made during rehabilitation sessions 1, 3, and 6 months after injury. Changes in UL activity and function over time were analyzed using linear mixed models. RESULTS During acute rehabilitation, the overall amount of UL activity and the active distance wheeled significantly increased in tetraplegic patients, but remained constant in paraplegic patients. The same tendency was shown in clinical scores with the exception of those for independence, which showed improvements at the beginning of the rehabilitation period, even in paraplegic subjects. In the later stages of acute rehabilitation, the quantity of UL activity in tetraplegic individuals matched that of their paraplegic counterparts, despite their greater motor impairments. Both subject groups showed higher UL activity during therapy time compared to the time outside of therapy time. CONCLUSION Tracking day-to-day UL activity is necessary to gain insights into the real impact of a patient's impairments on their UL movements during therapy and during their leisure time. In the future, this novel methodology may be used to reliably control and adjust ABRT and to evaluate the progress of UL rehabilitation in clinical trials.
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Affiliation(s)
- Michael Brogioli
- Spinal Cord Injury Center, Balgrist University Hospital , Zurich , Switzerland
| | - Sophie Schneider
- Spinal Cord Injury Center, Balgrist University Hospital , Zurich , Switzerland
| | - Werner L Popp
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland; Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Urs Albisser
- Spinal Cord Injury Center, Balgrist University Hospital , Zurich , Switzerland
| | - Anne K Brust
- Clinical Trial Unit, Swiss Paraplegic Centre , Nottwil , Switzerland
| | | | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich , Zurich , Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital , Zurich , Switzerland
| | - Michelle L Starkey
- Spinal Cord Injury Center, Balgrist University Hospital , Zurich , Switzerland
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27
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Measures and Outcome Instruments for Pediatric Spinal Cord Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2016. [DOI: 10.1007/s40141-016-0126-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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28
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Sinnott KA, Dunn JA, Wangdell J, Johanson ME, Hall AS, Post MW. Measurement of Outcomes of Upper Limb Reconstructive Surgery for Tetraplegia. Arch Phys Med Rehabil 2016; 97:S169-81. [DOI: 10.1016/j.apmr.2015.10.110] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 09/18/2015] [Accepted: 10/20/2015] [Indexed: 10/21/2022]
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29
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Brogioli M, Popp WL, Albisser U, Brust AK, Frotzler A, Gassert R, Curt A, Starkey ML. Novel Sensor Technology To Assess Independence and Limb-Use Laterality in Cervical Spinal Cord Injury. J Neurotrauma 2016; 33:1950-1957. [PMID: 27025797 DOI: 10.1089/neu.2015.4362] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
After spinal cord injury (SCI), levels of independence are commonly assessed with standardized clinical assessments. However, such tests do not provide information about the actual extent of upper limb activities or the impact on independence of bi- versus unilateral usage throughout daily life following cervical SCI. The objective of this study was to correlate activity intensity and laterality of upper extremity activity measured by body-fixed inertial measurement units (IMUs) with clinical assessment scores of independence. Limb-use intensity and laterality of activities performed by the upper extremities was measured in 12 subjects with cervical SCI using four IMUs (positioned on both wrists, on the chest, and on one wheel of the wheelchair). Algorithms capable of reliably detecting self-propulsion and arm activity in a clinical environment were applied to rate functional outcome levels, and were related to clinical independence measures during inpatient rehabilitation. Measures of intensity of upper extremity activity during self-propulsion positively correlated (p < 0.05, r = 0.643) with independence measures related to mobility. Clinical measures of laterality were positively correlated (p < 0.01, r = 0.900) with laterality as measured by IMUs during "daily life," and increased laterality was negatively correlated (p < 0.01, r = -0.739) with independence. IMU sensor technology is sensitive in assessing and quantifying upper limb-use intensity and laterality in human cervical SCI. Continuous and objective movement data of distinct daily activities (i.e., mobility and day-to-day activities) can be related to levels of independence. Therefore, IMU sensor technology is suitable not only for monitoring activity levels during rehabilitation (including during clinical trials) but could also be used to assess levels of participation after discharge.
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Affiliation(s)
- Michael Brogioli
- 1 Spinal Cord Injury Center, Balgrist University Hospital , Zurich, Switzerland
| | - Werner L Popp
- 1 Spinal Cord Injury Center, Balgrist University Hospital , Zurich, Switzerland .,2 Rehabilitation Engineering Laboratory , Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Urs Albisser
- 1 Spinal Cord Injury Center, Balgrist University Hospital , Zurich, Switzerland
| | - Anne K Brust
- 3 Swiss Paraplegic Centre , Nottwil, Switzerland
| | | | - Roger Gassert
- 2 Rehabilitation Engineering Laboratory , Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Armin Curt
- 1 Spinal Cord Injury Center, Balgrist University Hospital , Zurich, Switzerland
| | - Michelle L Starkey
- 1 Spinal Cord Injury Center, Balgrist University Hospital , Zurich, Switzerland
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30
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Kalsi-Ryan S, Beaton D, Ahn H, Askes H, Drew B, Curt A, Popovic MR, Wang J, Verrier MC, Fehlings MG. Responsiveness, Sensitivity, and Minimally Detectable Difference of the Graded and Redefined Assessment of Strength, Sensibility, and Prehension, Version 1.0. J Neurotrauma 2016; 33:307-14. [DOI: 10.1089/neu.2015.4217] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sukhvinder Kalsi-Ryan
- Department of Physical Therapy, Toronto Western Hospital, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- Krembil Neuroscience Centre, Toronto Western Hospital, Toronto, Ontario, Canada
- University Health Network, Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
- GRASSP Longitudinal Study Team
| | - Dorcas Beaton
- Department of Occupational Therapy, St. Michaels Hospital, Toronto, Ontario, Canada
- Rehabilitation Science Institute, St. Michaels Hospital, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- St. Michael's Hospital, Toronto, Ontario, Canada
| | - Henry Ahn
- Department of Surgery, St. Michaels Hospital, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- St. Michael's Hospital, Toronto, Ontario, Canada
- GRASSP Longitudinal Study Team
| | - Heather Askes
- GRASSP Longitudinal Study Team
- Spinal Cord Injury Research, St. Joseph's Health Care, London, Ontario, Canada
| | | | - Armin Curt
- Spinal Cord Injury Centre, University Hospital Balgrist, Zurich, Switzerland
- GRASSP Longitudinal Study Team
| | - Milos R. Popovic
- Rehabilitation Science Institute, St. Michaels Hospital, Toronto, Ontario, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- University Health Network, Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
- GRASSP Longitudinal Study Team
| | - Justin Wang
- Krembil Neuroscience Centre, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Mary C. Verrier
- Department of Physical Therapy, Toronto Western Hospital, Toronto, Ontario, Canada
- Rehabilitation Science Institute, St. Michaels Hospital, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- University Health Network, Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
- GRASSP Longitudinal Study Team
| | - Michael G. Fehlings
- Department of Surgery, St. Michaels Hospital, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- Krembil Neuroscience Centre, Toronto Western Hospital, Toronto, Ontario, Canada
- University Health Network, Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
- GRASSP Longitudinal Study Team
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31
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Dobkin BH, Carmichael ST. The Specific Requirements of Neural Repair Trials for Stroke. Neurorehabil Neural Repair 2015; 30:470-8. [PMID: 26359342 DOI: 10.1177/1545968315604400] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Novel molecular, cellular, and pharmacological therapies to stimulate repair of sensorimotor circuits after stroke are entering clinical trials. Compared with acute neuroprotection and thrombolysis studies, clinical trials for repair in subacute and chronic hemiplegic participants have a different time course for delivery of an intervention, different mechanisms of action within the milieu of the injury, distinct relationships to the amount of physical activity and skills practice of participants, and need to include more refined outcome measures. This review examines the biological interaction of targeted rehabilitation with neural repair strategies to optimize outcomes. We suggest practical guidelines for the incorporation of inexpensive skills training and exercise at home. In addition, we describe some novel outcome measurement tools, including wearable sensors, to obtain the more detailed outcomes that may identify at least some minimal level of success from cellular and regeneration interventions. Thus, proceeding in the shadow of acute stroke trial designs may unnecessarily limit the mechanisms of action of new repair strategies, reduce their impact on participants, and risk missing important behavioral outcomes.
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Affiliation(s)
- Bruce H Dobkin
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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32
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Velstra IM, Bolliger M, Krebs J, Rietman JS, Curt A. Predictive Value of Upper Limb Muscles and Grasp Patterns on Functional Outcome in Cervical Spinal Cord Injury. Neurorehabil Neural Repair 2015; 30:295-306. [DOI: 10.1177/1545968315593806] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective. To determine which single or combined upper limb muscles as defined by the International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI); upper extremity motor score (UEMS) and the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP), best predict upper limb function and independence in activities of daily living (ADLs) and to assess the predictive value of qualitative grasp movements (QlG) on upper limb function in individuals with acute tetraplegia. Method. As part of a Europe-wide, prospective, longitudinal, multicenter study ISNCSCI, GRASSP, and Spinal Cord Independence Measure (SCIM III) scores were recorded at 1 and 6 months after SCI. For prediction of upper limb function and ADLs, a logistic regression model and unbiased recursive partitioning conditional inference tree (URP-CTREE) were used. Results. Logistic regression and URP-CTREE revealed that a combination of ISNCSCI and GRASSP muscles (to a maximum of 4) demonstrated the best prediction (specificity and sensitivity ranged from 81.8% to 96.0%) of upper limb function and identified homogenous outcome cohorts at 6 months. The URP-CTREE model with the QlG predictors for upper limb function showed similar results. Conclusion. Prediction of upper limb function can be achieved through a combination of defined, specific upper limb muscles assessed in the ISNCSCI and GRASSP. A combination of a limited number of proximal and distal muscles along with an assessment of grasping movements can be applied for clinical decision making for rehabilitation interventions and clinical trials.
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Affiliation(s)
| | - Marc Bolliger
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- European Multicenter Study about Human Spinal Cord Injury (EMSCI), Zurich, Switzerland
| | - Jörg Krebs
- Clinical Trial Unit, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Johan S. Rietman
- Roessingh Research and Development, Lab of Biomechanical Engineering, University of Twente, Enschede, Netherlands
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- European Multicenter Study about Human Spinal Cord Injury (EMSCI), Zurich, Switzerland
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