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Hammelef E, Zakaria SJ, Andersen SH, Kelly TJ, Grampurohit N, Avery M, Napoli A, Mulcahey MJ, Serruya MD. A Pilot Feasibility Trial of an Upper Extremity Assistive System. Arch Rehabil Res Clin Transl 2023; 5:100308. [PMID: 38163018 PMCID: PMC10757169 DOI: 10.1016/j.arrct.2023.100308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Objective To develop and clinically evaluate a customizable active upper extremity (UE) assistive system with integrated functional electrical stimulation (FES) that improves function and independence of individuals during activities of daily living (ADLs). Design Single-arm, prospective, open-label cohort feasibility trial. Setting An academic research institution. Participants Subjects were 5 adults with a medical history of stroke resulting in distal UE impairment (N=5). The subjects volunteered from recruitment materials that detailed information about the study. Interventions A novel, wearable, lightweight, low-profile, and patient-tailored UE assistive system. It comprises a splint component and FES unit that may each be controlled by electromyography (EMG) signals, inertial measurement units (IMUs), manual control source (joystick), and/or voice control. Main Outcome Measures Several occupational therapy outcome measures were used, including the Canadian Occupational Performance Measure (COPM), Action Research Arm Test (ARAT), The Box and Blocks Test (BBT), the ABILHAND-Manual Ability Measure, and Patient Reported Outcomes Measurement Information System (PROMIS) UE Short Form. Results All participants learned to use our UE assistive system to perform ADLs and were able to use it independently at home. Most participants experienced a clinically meaningful improvement in both performance and satisfaction for the majority of their COPM goals while using the system. All participants experienced improvement in hand grip and release as shown by their baseline and post assessment scores for hand function (BBT, ARAT) and patient-reported outcomes (ABILHAND, PROMIS). Conclusions The clinical outcomes suggest that our UE assistive system improves functional performance in patients with UE impairment, allowing them to engage more actively in ADLs. Further innovation including elbow and shoulder components will allow users to have more degrees of freedom during tasks.
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Affiliation(s)
- Emma Hammelef
- Raphael Center for Neurorestoration, Farber Institute for Neuroscience, Thomas Jefferson University, 130 S 9th Street, Suite 2400, Philadelphia, PA 19107
| | - Saami J. Zakaria
- Raphael Center for Neurorestoration, Farber Institute for Neuroscience, Thomas Jefferson University, 130 S 9th Street, Suite 2400, Philadelphia, PA 19107
| | - Sarah H. Andersen
- Raphael Center for Neurorestoration, Farber Institute for Neuroscience, Thomas Jefferson University, 130 S 9th Street, Suite 2400, Philadelphia, PA 19107
| | - Thomas J. Kelly
- Raphael Center for Neurorestoration, Farber Institute for Neuroscience, Thomas Jefferson University, 130 S 9th Street, Suite 2400, Philadelphia, PA 19107
| | - Namrata Grampurohit
- Center for Outcomes and Measurement, College of Rehabilitation Sciences, Thomas Jefferson University, 901 Walnut Street, Suite 642, Philadelphia, PA 19107
| | - Mikael Avery
- Raphael Center for Neurorestoration, Farber Institute for Neuroscience, Thomas Jefferson University, 130 S 9th Street, Suite 2400, Philadelphia, PA 19107
- Studio Krea, Collingswood, NJ
| | - Alessandro Napoli
- Raphael Center for Neurorestoration, Farber Institute for Neuroscience, Thomas Jefferson University, 130 S 9th Street, Suite 2400, Philadelphia, PA 19107
| | - Mary Jane Mulcahey
- Center for Outcomes and Measurement, College of Rehabilitation Sciences, Thomas Jefferson University, 901 Walnut Street, Suite 642, Philadelphia, PA 19107
| | - Mijail Demian Serruya
- Raphael Center for Neurorestoration, Farber Institute for Neuroscience, Thomas Jefferson University, 130 S 9th Street, Suite 2400, Philadelphia, PA 19107
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Biller OM, Biundo J, Mitchell ESL, Richardson B, Burkhart I, Kim RY, Gerhardt NM, Mulcahey MJ. Promoting community engagement in spinal cord injury research: a case example. Spinal Cord 2023; 61:632-635. [PMID: 37591948 DOI: 10.1038/s41393-023-00926-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/28/2023] [Accepted: 08/02/2023] [Indexed: 08/19/2023]
Abstract
Community engagement is an important method of knowledge translation in spinal cord injury (SCI) research where researchers collaborate with people with lived experience, care partners, and other research users to improve the quality of research. This perspective article aims to promote community engagement in SCI research by describing useful resources for its implementation and providing an example project using the North American Spinal Cord Injury Consortium (NASCIC) process for such partnerships. Researchers from the Jefferson College of Rehabilitation Sciences' (JCRS) Center for Outcomes and Measurement engaged NASCIC to create an advisory committee composed of four people living with SCI to make recommendations for the methods of a large-scale study to develop a clinical outcome assessment. The advisory committee made usable recommendations for enhancing recruitment methods and reducing burden and barriers to participation. The successful partnership between NASCIC and JCRS shows the feasibility and value of SCI community engagement in research.
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Affiliation(s)
- Olivia M Biller
- Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
- Janssen Pharmaceuticals, LLC, Raritan, NJ, USA
| | - Jason Biundo
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA
| | | | | | - Ian Burkhart
- The North American Spinal Cord Injury Consortium, Buffalo, NY, USA
| | - Rachel Y Kim
- Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nicole M Gerhardt
- Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA.
| | - M J Mulcahey
- Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
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Krisa L, Witoslawski E, Jones L, Mulcahey MJ, Fouad K. Connecting Researchers and Clinicians Before Connecting the Injured Spinal Cord. Top Spinal Cord Inj Rehabil 2023; 29:14-30. [PMID: 38076290 PMCID: PMC10644858 DOI: 10.46292/sci22-00044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Background Translating research findings from animal models of spinal cord injury (SCI) to humans is a challenging enterprise. It is likely that differences in the use of common terms contribute to this. Objectives The purpose of this study was to identify how scientists and clinicians define terms used across the research and clinical care continuum. Methods We utilized the Delphi technique to develop consensus on the opinions of experts (defined as researchers and/or clinicians working in the field of SCI) through a series of structured, iterative surveys. A focus group of stakeholders developed the terms on the initial survey. Results were used to create definitions and formulate questions for a second and third survey. Results Survey 1 yielded one definition for eight terms and multiple definitions for six terms in addition to three new terms that respondents believed should be defined. In Survey 2, definitions for eight terms reached at least 80% agreement: anatomically complete spinal cord injury, functionally complete spinal cord injury, neuromodulation, physical exercise, physical rehabilitation, plasticity, task specificity, and training intensity. Consensus was not reached for six terms. In Survey 3, definitions for seven additional terms reached at least 80% agreement: recovery, repair, compensation, regeneration, physical function, physiological function, and chronic. There were three terms that did not reach agreement after the three rounds: acute, translational research, and sprouting. Conclusion We found that different terminology contributes to the gap between preclinical and clinical research and clinical application. This suggests that increased communication among different disciplines could be a way to advance the field.
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Affiliation(s)
- Laura Krisa
- Department of Physical Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Erica Witoslawski
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Linda Jones
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - MJ Mulcahey
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Karim Fouad
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta
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Varni JW, Zebracki K, Hwang M, Mulcahey MJ, Vogel LC. Bladder and bowel function effects on emotional functioning in youth with spinal cord injury: a serial multiple mediator analysis. Spinal Cord 2023; 61:415-421. [PMID: 37414836 DOI: 10.1038/s41393-023-00912-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 06/25/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023]
Abstract
STUDY DESIGN Preliminary explanatory or mechanistic cross-sectional study. OBJECTIVES This preliminary cross-sectional study investigates the hypothesized serial mediating effects of bladder/bowel worry, social worry, and social participation in the relationship between bladder function or bowel function and emotional functioning in youth with spinal cord injury (SCI) from their perspective. METHODS The Bladder Function, Bowel Function, Worry Bladder Bowel, Worry Social, and Social Participation Scales from the PedsQL™ Spinal Cord Injury Module and the Emotional Functioning Scale from the PedsQL™ 4.0 Generic Core Scales Short Form SF15 were completed by 127 youth with SCI ages 8-24. Serial multiple mediator model analyses were conducted to test the hypothesized sequential mediating effects of bladder/bowel worry, social worry, and social participation as intervening variables separately for the cross-sectional association between bladder function or bowel function and emotional functioning. RESULTS The separate cross-sectional negative association of bladder function and bowel function with emotional functioning were serially mediated by bladder/bowel worry, social worry and social participation, accounting for 28% and 31%, respectively, of the variance in youth-reported emotional functioning (p < 0.001), representing large effect sizes. CONCLUSIONS In this preliminary study, bladder/bowel worry, social worry, and social participation explain in part the cross-sectional negative association of bladder function and bowel function with emotional functioning in youth with SCI from the youth perspective. Identifying the hypothesized associations of bladder function and bowel function, bladder/bowel worry, social worry, and social participation with emotional functioning may help inform future clinical research and practice for youth with SCI.
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Affiliation(s)
- James W Varni
- Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, College Station, TX, USA.
| | - Kathy Zebracki
- Shriners Children's Chicago, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Mary Jane Mulcahey
- Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Department of Physical Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lawrence C Vogel
- Shriners Children's Chicago, Chicago, IL, USA
- Department of Pediatrics, Rush Medical College, Chicago, IL, USA
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Kim RY, Thielen CC, Heydeman G, Mulcahey MJ. Standardized administration and scoring guidelines for the Spinal Cord Independence Measure Version 3.0 (SCIM-III). Spinal Cord 2023; 61:296-306. [PMID: 36966259 DOI: 10.1038/s41393-023-00891-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/22/2023] [Accepted: 03/10/2023] [Indexed: 03/27/2023]
Abstract
STUDY DESIGN Qualitative studies. OBJECTIVE To develop clear and specific administration and scoring procedures for the Spinal Cord Independence Measure Version 3.0 as a performance-based and interview assessment. SETTING Research lab. METHODS Modified Delphi Technique survey methods were used in this study. Previously developed SCIM-III administration and scoring procedures for performance-based and interview versions were presented to clinicians experienced in SCI and SCIM-III using the Qualtrix (Qualtrics, Provo, UT) online survey platform. Summary and descriptive statistics were used to assess the percent agreement survey responses. RESULTS Three survey rounds were necessary to achieve 80% agreement or above for the performance-based version. Two survey rounds were necessary to achieve 80% agreement or above on the interview version. CONCLUSIONS This study describes the development of standardized administration and scoring procedures for the self-care and mobility sub-scales of the SCIM-III as a performance-based and interview version.
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Affiliation(s)
- Rachel Y Kim
- Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Christina Calhoun Thielen
- Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - M J Mulcahey
- Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
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Kim R, Grampurohit N, Gerhardt N, Potvin MC, Mulcahey MJ. Development and Validation of Fidelity of Coaching for Spinal Cord Injury. Arch Phys Med Rehabil 2023. [DOI: 10.1016/j.apmr.2022.12.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Kim R, Gerhardt N, Mulcahey MJ. Development of Performance-based Outcome Assessment for Acute Spinal Cord Injury. Arch Phys Med Rehabil 2023. [DOI: 10.1016/j.apmr.2022.12.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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Varni JW, Zebracki K, Hwang M, Mulcahey MJ, Vogel LC. Pain, pain interference, social and school/work functioning in youth with spinal cord injury: A mediation analysis. J Spinal Cord Med 2022:1-7. [PMID: 36149340 DOI: 10.1080/10790268.2022.2120232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Context/Objective: The objective of the present study was to investigate the effects of pain severity, pain interference and social functioning in a serial multiple mediator model predicting school/work functioning in youth with spinal cord injury (SCI) from their perspective.Design: Explanatory or mechanistic study.Setting: Pediatric specialty hospital.Participants: 125 youth with SCI ages 8-24.Outcome Measures: The Pain Severity Item and Pain Interference Scale from the PedsQL™ Spinal Cord Injury Module, and the Social Functioning and School/Work Functioning Scales from the PedsQL™ 4.0 Generic Core Scales Short Form SF15 were completed.Results: Hierarchical multiple regression and serial multiple mediator model analyses were conducted to test the percent variability accounted for and the mediating effects of pain interference and social functioning in the association between pain severity and school/work functioning. Pain predictive effects on school/work functioning were serially mediated by pain interference and social functioning. In a predictive analytics model conducted with hierarchical multiple regression analysis, age, sex, pain, pain interference and social functioning accounted for 45% of the variance in youth-reported school/work functioning (P < 0.001), demonstrating a large effect size.Conclusion: The mechanisms of the predictive effects of pain severity on school/work functioning in youth with SCI are explained in part by the serial multiple mediator effects of pain interference and social functioning. Identifying the multiple mediators of SCI pain on school/work functioning from the perspective of youth with SCI may facilitate future clinical research and practice to ameliorate impaired daily functioning and improve overall well-being.
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Affiliation(s)
- James W Varni
- Department of Pediatrics, College of Medicine, Texas A&M University, College Station, Texas, USA
- Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, College Station, Texas, USA
| | - Kathy Zebracki
- Shriners Children's Chicago, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Miriam Hwang
- Shriners Children's Chicago, Chicago, Illinois, USA
| | - M J Mulcahey
- Department of Physical Medicine, Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Lawrence C Vogel
- Shriners Children's Chicago, Chicago, Illinois, USA
- Department of Pediatrics, Rush Medical College, Chicago, Illinois, USA
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Grampurohit N, Gerhardt N, Kim RN, Santacroce D, Sivori TT, Santos G, Alpajora B, Piersol CV, Mulcahey MJ. Postdischarge Telehealth Support for Caregivers Through a Coaching Approach: A Case Study. Am J Occup Ther 2022. [DOI: 10.5014/ajot.2022.76s1-po204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Date Presented 04/02/2022
Coaching care partners through the transition from hospital to home can be beneficial for both the caregiver and the care recipient. In this case study, we describe the benefits of coaching the caregiver postdischarge through a telehealth coaching-in-context approach. Both care partners made remarkable gains in occupational performance, self-efficacy, and quality of life. The preliminary data presented here are part of a pilot randomized controlled trial that compares coaching with usual care.
Primary Author and Speaker: Namrata Grampurohit
Contributing Authors: Nicole Gerhardt, Rachel Namrata Kim, David Santacroce, Taylor T. Sivori, Gabriella Santos, Bernadette Alpajora, Catherine Verrier Piersol, Mary Jane Mulcahey
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Affiliation(s)
| | - Nicole Gerhardt
- Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | | | | | - Taylor T. Sivori
- Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Gabriella Santos
- Kessler Institute for Rehabilitation, Chester, New Jersey, United States
| | - Bernadette Alpajora
- Jefferson College of Rehabilitation Sciences, Philadelphia, Pennsylvania, United States
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Russo SA, Topley MT, Richardson RT, Richards JG, Chafetz RS, Rapp van Roden EA, Zlotolow DA, Mulcahey MJ, Kozin SH. Assessment of the relationship between Brachial Plexus Profile activity short form scores and modified Mallet scores. J Hand Ther 2022; 35:51-57. [PMID: 33308927 DOI: 10.1016/j.jht.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/19/2020] [Accepted: 10/09/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION This study aims to assess the relationship between the modified Mallet classification and the Brachial Plexus Profile activity short form (BP-PRO activity SF). The therapist or surgeon classifies upper extremity movement for the modified Mallet classification, while the BP-PRO assesses parents' perceptions of difficulty performing activities. PURPOSE To provide a deeper understanding of the relationship of functional and perceived outcome measurements. STUDY DESIGN Prospective, correlational design. METHODS Eighty children with brachial plexus birth injuries were evaluated using the modified Mallet classification, while parents simultaneously answered the BP-PRO activity SF questions. All patients had undergone one of three surgical interventions to improve shoulder function. The relationship between the two measures, patient injury levels, and surgical histories were assessed. RESULTS The average modified Mallet scores and BP-PRO activity SF scores weakly correlated (r = 0.312, P = .005) and both measures differentiated between C5-6 and C5-7 injury levels (P = .03 and P = .02, respectively). Conversely, the modified Mallet scores could differentiate between the three surgical groups (F = 8.2, P < .001), while the BP-PRO activity SF could not (P = .54). CONCLUSION The results suggest that these tools measure different aspects of patient outcomes. The Mallet classification may be more focused on shoulder motion than the BP-PRO activity SF. Additional questions that specifically require shoulder function could be incorporated into the BP-PRO activity SF to improve understanding of patient/parent perceptions of shoulder function for children with brachial plexus injuries. Clinicians should be aware of the strengths, weaknesses, and limitations of each outcome assessment tool for appropriate use and interpretation of results.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Scott H Kozin
- Shriners Hospital for Children, Philadelphia, PA, USA
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Faro SH, Saksena S, Krisa L, Middleton DM, Alizadeh M, Finsterbusch J, Flanders AE, Talekar K, Mulcahey MJ, Mohamed FB. DTI of chronic spinal cord injury in children without MRI abnormalities (SCIWOMR) and with pathology on MRI and comparison to severity of motor impairment. Spinal Cord 2022; 60:457-464. [PMID: 35379960 DOI: 10.1038/s41393-022-00770-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 12/16/2021] [Accepted: 02/04/2022] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN This investigation was a cohort study that included: 36 typically developing (TD) children and 19 children with spinal cord lesions who underwent spinal cord MRI. OBJECTIVES To investigate diffusion tensor imaging (DTI) cervical and thoracic spinal cord changes in pediatric patients that have clinically traumatic and non-traumatic spinal cord injury (SCI) without MR (SCIWOMR) abnormalities. SETTING Thomas Jefferson University, Temple University, Shriners Hospitals for Children all in Philadelphia, USA. METHODS 36 TD children and 19 children with spinal cord lesions that represent either a chronic traumatic acquired SCI or chronic non-traumatic SCI (≥6 months post injury), age range, 6-16 years who underwent cervical and thoracic spinal cord MRI in 2014-2017. Additionally DTI was correlated to clinical American Spinal Injury Association Impairment Scale (AIS). RESULTS Both SCIWOMR and MRI positive (+) groups showed abnormal FA and RD DTI values in the adjacent MRI-normal appearing segments of cephalad and caudal spinal cord compared to TD. The FA values demonstrated perilesional abnormal DTI findings in the middle and proximal segments of the cephalad and caudal cord in the SCIWOMR AIS A/B group compared to SCIWOMR AIS C/D group. CONCLUSIONS We found DTI changes in children with SCIWOMR with different causes of spinal lesions. We also investigated the relationship between DTI and clinical AIS scores. This study further examined the potential diagnostic value of DTI and should be translatable to adults with spinal cord lesions.
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Affiliation(s)
- Scott H Faro
- Department of Radiology, Thomas Jefferson University, 909 Walnut Street, Philadelphia, PA, 19107, USA.
| | - Sona Saksena
- Department of Radiology, Thomas Jefferson University, 909 Walnut Street, Philadelphia, PA, 19107, USA
| | - Laura Krisa
- Department of Occupational Therapy, Thomas Jefferson University, 901 Walnut Street, 6th floor, Philadelphia, PA, 19107, USA.,Department of Physical Therapy, Thomas Jefferson University, 901 Walnut Street, 5th floor, Philadelphia, PA, 19107, USA
| | - Devon M Middleton
- Department of Radiology, Thomas Jefferson University, 909 Walnut Street, Philadelphia, PA, 19107, USA
| | - Mahdi Alizadeh
- Department of Neurosurgery, Thomas Jefferson University, 909 Walnut Street, Philadelphia, PA, 19107, USA
| | | | - Adam E Flanders
- Department of Radiology, Thomas Jefferson University, 909 Walnut Street, Philadelphia, PA, 19107, USA
| | - Kiran Talekar
- Department of Radiology, Thomas Jefferson University, 909 Walnut Street, Philadelphia, PA, 19107, USA
| | - M J Mulcahey
- Department of Physical Therapy, Thomas Jefferson University, 901 Walnut Street, 5th floor, Philadelphia, PA, 19107, USA
| | - Feroze B Mohamed
- Department of Radiology, Thomas Jefferson University, 909 Walnut Street, Philadelphia, PA, 19107, USA
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Krisa L, Middleton DM, Saksena S, Faro SH, Leiby BE, Mohamed FB, Mulcahey MJ. Clinical Utility of Diffusion Tensor Imaging as a Biomarker to Identify Microstructural Changes in Pediatric Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2022; 28:1-12. [PMID: 35521062 PMCID: PMC9009200 DOI: 10.46292/sci21-00048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Lack of clarity about the neurological consequence of spinal cord injury (SCI) in children causes speculation about diagnoses, recovery potential, and treatment effectiveness. Diffusion tensor imaging (DTI) has shown promising results as a biomarker to evaluate spinal cord integrity at a microstructural level. Objectives To look at the difference between pediatric participants with and without SCI to determine which DTI metrics best categorize spinal cord tissue damage and to correlate DTI metrics with two clinical measures: Capabilities of the Upper Extremity Test (CUE-T) and Spinal Cord Independence Measure version III (SCIM-III). Methods This single-site, prospective study included pediatric participants with SCI (n = 26) and typically developed (TD) control subjects (n = 36). All participants underwent two magnetic resonance imaging (MRI) scans on a 3T MR scanner. Participants with SCI also completed the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), CUE-T, and SCIM-III outcomes measures. Results This study found significant strength of association between fractional anisotropy (FA) and upper extremity muscle strength (UEMS) in participants with SCI. Most DTI parameters showed a significant difference between participants with SCI and TD participants and a moderate correlation with the CUE-T total score. Regional effects on group differences were found to be significant. Conclusion This study demonstrates the strength of association between DTI parameters and clinical measures in the pedantic SCI population. It illustrates DTI as a potential biomarker of SCI location and severity in the pediatric SCI population.
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Affiliation(s)
- Laura Krisa
- Department of Physical Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
,Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
,Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Devon M. Middleton
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sona Saksena
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Scott H. Faro
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Benjamin E. Leiby
- Department of Pharmacology & Experimental Therapeutics, Biostatistics Division, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Feroze B. Mohamed
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - MJ Mulcahey
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
,Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania
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Dent K, Zebracki K, Sadowsky C, Martin R, Behrman A, Lipa B, Biering-Sørensen F, Vogel LC, Mulcahey MJ. Evaluation of the International Spinal Cord Injury Bowel Function Basic Data Set Version 2.0 in Children and Youth With Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2022; 28:21-33. [PMID: 35145332 PMCID: PMC8791417 DOI: 10.46292/sci19-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To establish the utility and feasibility of the International Spinal Cord Injury/Dysfunction (SCI/D) Bowel Function Basic Data Set Version 2.0 in pediatric SCI populations. METHODS This was a noninterventional, repeated measure design conducted in Pennsylvania, Maryland, Illinois, Kentucky, and South Carolina. The International Spinal Cord Injury/Dysfunction (SCI/D) Bowel Function Basic Data Set Version 2.0 was administered repeatedly, twice at the point of care and once over the phone. Time to complete the data set was recorded. Inter- and intrarater reliability was examined by intraclass correlation coefficients (ICC) with 95% confidence intervals (CI), and agreement between the bowel function basic data set variables and medical records was calculated using percentages. Intrarater reliability involved the same person administering the data once at the point of care and once over the phone. RESULTS Forty-one children/youth ages 1 to 20 years participated in this study. Average time to complete the data set was 5.17 minutes. Interrater reliability was good to excellent (ICC ≥ 0.75) for most variables. Five variables had moderate interrater reliability (ICC = 0.05-0.74) and three had poor interrater reliability (ICC < 0.05). With the exception of one variable that had poor intrarater reliability (constipating agent, ICC = 0.00) and one that approached moderate reliability (digital evacuation, ICC = 0.74), intrarater reliability was good to strong for every bowel variable (ICC = 0.88-1.00). Only 12 (32%) medical records had explicit documentation of one or more of the variables on the Basic Bowel Function Basic Data Set V2.0. CONCLUSION The results support future research with a larger and more diverse sample of children with SCI to build upon the psychometric work described herein.
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Affiliation(s)
- Kathryn Dent
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Cristina Sadowsky
- International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, Maryland
,Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Rebecca Martin
- International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, Maryland
| | - Andrea Behrman
- Department of Neurosurgery, Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky
| | - Bethany Lipa
- Shriners Hospitals for Children, Philadelphia, Pennsylvania
| | - Fin Biering-Sørensen
- Section for Spinal Cord Injuries, Department for Brain and Spinal Cord Injuries, Rigshospitalet, HornBaek, Denmark
,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - MJ Mulcahey
- Center for Outcomes and Measurement & Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania
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McIntyre A, Sadowsky C, Behrman A, Martin R, Augutis M, Cassidy C, Betz R, Ertzgaard P, Mulcahey MJ. A Systematic Review of the Scientific Literature for Rehabilitation/Habilitation Among Individuals With Pediatric-Onset Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2022; 28:13-90. [PMID: 35521053 PMCID: PMC9009193 DOI: 10.46292/sci21-00046] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objectives To conduct a systematic review to examine the scientific literature for rehabilitation/habilitation among individuals with pediatric-onset spinal cord injury (SCI). Methods A literature search of multiple databases (i.e., PubMed/MEDLINE, CINAHL, EMBASE, PsychINFO) was conducted and was filtered to include studies involving humans, published as full-length articles up to December 2020, and in English. Included studies met the following inclusion criteria: (1) ≥50% of the study sample had experienced a traumatic, acquired, nonprogressive spinal cord injury (SCI) or a nontraumatic, acquired, noncongenital SCI; (2) SCI onset occurred at ≤21 years of age; and (3) sample was assessed for a rehabilitation/habilitation-related topic. Studies were assigned a level of evidence using an adapted Sackett scale modified down to five levels. Data extracted from each study included author(s), year of publication, country of origin, study design, subject characteristics, rehabilitation/habilitation topic area, intervention (if applicable), and outcome measures. Results One hundred seventy-six studies were included for review (1974-2020) with the majority originating from the United States (81.3%). Most studies were noninterventional observational studies (n = 100; 56.8%) or noninterventional case report studies (n = 5; 2.8%). Sample sizes ranged from 1 to 3172 with a median of 26 (interquartile range [IQR], 116.5). Rehabilitation/habilitation topics were categorized by the International Classification of Functioning, Disability and Health (ICF); most studies evaluated ICF Body Function. There were 69 unique clinical health outcome measures reported. Conclusion The evidence for rehabilitation/habilitation of pediatric-onset SCI is extremely limited; nearly all studies (98%) are level 4-5 evidence. Future studies across several domains should be conducted with novel approaches to research design to alleviate issues related to sample sizes and heterogeneity.
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Affiliation(s)
- Amanda McIntyre
- Parkwood Institute Research, Parkwood Institute, London, Canada
| | - Cristina Sadowsky
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, John Hopkins University, Baltimore, Maryland
,International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, Maryland
| | - Andrea Behrman
- Department of Neurological Surgery, Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky
,Kosair Charities Center for Pediatric Neurorecovery, Louisville, Kentucky
| | - Rebecca Martin
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, John Hopkins University, Baltimore, Maryland
,International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, Maryland
| | - Marika Augutis
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institute, Solna, Sweden
| | - Caitlin Cassidy
- St. Joseph’s Health Care London, Parkwood Institute, London, Canada
| | - Randal Betz
- Institute for Spine and Scoliosis, Lawrenceville, New Jersey
,Department of Orthopedics, Mount Sinai Hospital, New York, New York
| | - Per Ertzgaard
- Department of Rehabilitation Medicine, Linköping University, Linköping, Sweden
| | - MJ Mulcahey
- Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Woodbury, New Jersey
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15
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Shaw A, Cabrejo PT, Adamczyk A, Mulcahey MJ. Reducing Hospital Readmissions of Older Adults Pursuing Postacute Care at Skilled Nursing Facilities: A Scoping Review. Am J Occup Ther 2022; 76:23144. [PMID: 34997839 DOI: 10.5014/ajot.2022.049082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Unplanned hospital readmissions can profoundly affect older adults' quality of life and the financial status of skilled nursing facilities (SNFs). Although many clinical practices focus on reforming these issues, occupational therapy's involvement remains unclear. OBJECTIVE To explore clinical practices aimed at reducing hospital readmissions of older adults pursuing postacute care (PAC) at SNFs and describe how they align with occupational therapy's scope of practice. DATA SOURCES We searched CINAHL, Scopus, PubMed, and OTseeker for articles published from January 2011 to February 2020. Study Selection and Data Collection: We conducted a scoping review of peer-reviewed articles with functional outcomes of clinical practices reducing unplanned hospital readmissions of patients older than age 65 yr pursuing PAC services in SNFs. Trained reviewers completed the title and abstract screens, full-text reviews, and data extraction. FINDINGS Thirteen articles were included and focused on five areas: risk and medical disease management and follow-up, hospital-to-SNF transition, enhanced communication and care, function, and nutrition. Early coordination of care and early identification of patients' needs and risk of readmission were common features. All clinical practices aligned with occupational therapy domains and processes, but only 1 study specified occupational therapy as part of the research team. CONCLUSIONS AND RELEVANCE Comprehensive, multipronged clinical practices encompassing care coordination and early identification and management of acute conditions are critical in reducing preventable readmissions among older adults pursuing PAC services in SNFs. Further research is needed to support occupational therapy's value in preventing hospital readmissions of older adults in this setting. What This Article Adds: This scoping review maps the presence of occupational therapy's domains and processes in the clinical practices that reduce hospital readmissions of older adults pursuing PAC services in SNFs. Findings provide occupational therapy practitioners with opportunities to assume roles beyond direct patient care, research, advocate, and publish more, thereby increasing their presence and adding value to occupational therapy interventions that reduce hospital readmissions.
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Affiliation(s)
- Antoinette Shaw
- Antoinette Shaw, OTD, OTR/L, is Director of Rehabilitation Services, Genesis Healthcare Corporation, Catonsville, MD;
| | - Pamela Talero Cabrejo
- Pamela Talero Cabrejo, OTD, OTR/L, is Adjunct Assistant Professor, Post-Professional Occupational Therapy Program, Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA
| | - Abby Adamczyk
- Abby Adamczyk, MLIS, AHIP, is Professional Librarian, Thomas Jefferson University, Philadelphia, PA
| | - M J Mulcahey
- MJ Mulcahey, PhD, OTR/L, is Professor of Occupational Therapy, Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA
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16
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Mulcahey MJ, Gerhardt N, Alpajora B, Thielen CC, Dunn W. Coaching-in-Context With Informal Maternal Care Partners of Children With Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2022; 28:99-113. [PMID: 35145338 PMCID: PMC8791418 DOI: 10.46292/sci21-00045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Coaching-in-Context (CinC) is a conversation-based process for working with people that draws on the tenets of positive psychology, is solution-focused and strength-based, and uses evidence-informed coaching techniques that create opportunities for clients to be at their best when engaging in the roles and activities that are desired, required, or expected of them. OBJECTIVES To explore the use of CinC with informal maternal care partners (mothers, grandmothers) of children with spinal cord injury (SCI). METHODS This study was a multicenter, single group, pre-post treatment design. Participants received up to 10 sessions of CinC over a 10-week period. The Canadian Occupational Performance Measure (COPM), Parenting Stress Index, Fourth Edition Short Form (PSI-4-SF), and Pediatric Measure of Participation Short Form (PMoP SF) were administered before and after coaching. The number of coaching sessions completed, missed, and rescheduled was recorded. Descriptive and nonparametric statistics were used to summarize sample characteristics and to evaluate changed COPM scores. PSI-4-SF stress percentiles were examined descriptively. Wilcoxon signed-rank test was used to determine whether there was a statistically significant change between baseline and postcoaching COPM and PMoP SF scores. RESULTS Nine caregivers enrolled in the study; two had face-to-face coaching, five had phone coaching, and two dropped out. The seven who completed were mothers with an average age of 37.14 (range, 32-45; SD = 5.15) years, with children an average age of 10 (range, 7-13; SD = 2.89) years with paraplegia (n = 4) or tetraplegia (n = 3) sustained an average of 6.71 (range, 2-13; SD = 3.73) years prior to the study. Fifty-five (average = 7.86, mode = 9; range, 3-10) coaching sessions were provided; two sessions were missed and nine were rescheduled. After coaching, mean COPM performance scores increased by 2.48 (SD = 2.01) (Z = -4.057, p < .001), mean COPM satisfaction scores increased by 2.81 (SD = 1.33) (Z = -4.812, p < .001), and PMoP self scores increased (Z = -2.023, p < .043). CONCLUSION This study provides preliminary support for CinC with informal care partners of children with SCI. It also highlights several factors that are important to consider when implementing a coaching program, namely mode of delivery and time commitment.
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Affiliation(s)
- MJ Mulcahey
- Center for Outcomes and Measurement & Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Nicole Gerhardt
- Center for Outcomes and Measurement & Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Christina Calhoun Thielen
- Center for Outcomes and Measurement & Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Winnie Dunn
- Department of Occupational Therapy, University of Missouri, Columbia, Missouri
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Abstract
OBJECTIVES The objective was to report on the initial measurement properties of the Pediatric Quality of Life Inventory™ (PedsQL™) Spinal Cord Injury (SCI) Module in youth with SCI from the youth and parent perspectives. METHODS PedsQL™ SCI Module and PedsQL™ 4.0 Generic Core Scales SF15 were completed in a multisite national study by 166 youth ages 8 to 25 years and 128 parents of youth ages 5 to 23 years. Data from the PedsQL™ Generic Core Scales were compared with an age- and sex-matched healthy control sample. Factor analysis was conducted to determine the factor structure of the items. RESULTS In addition to a Total Scale Score, nine unidimensional scales were derived measuring daily activities, mobility, bladder function, bowel function, pressure injury, pain interference, social participation, worry bladder bowel, and worry social. The PedsQL™ SCI Module evidenced excellent reliability for Total Scale Scores (youth self-report, α = 0.93; parent proxy-report, α = 0.93) and acceptable reliability for the nine individual scales (youth self-report, α = 0.71-0.83; parent proxy-report, α = 0.67-0.87). Intercorrelations with the Generic Core Scales supported construct validity with medium to large effect sizes (most ps < .001). Factor analysis supported the unidimensionality of the nine individual scales. PedsQL™ Generic Core Scales comparisons to healthy controls demonstrated significantly impaired generic health-related quality of life in youth with SCI with large effect sizes. CONCLUSION The PedsQL™ SCI Module Scales demonstrated acceptable measurement properties and may be utilized as standardized scales to assess SCI-specific concerns and problems in clinical research and practice in youth with SCI.
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Affiliation(s)
- Kathy Zebracki
- Shriners Children’s Chicago, Illinois
,Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Lawrence C. Vogel
- Shriners Children’s Chicago, Illinois
,Rush Medical College, Chicago, Illinois
| | - MJ Mulcahey
- Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Department of Physical Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - James W. Varni
- Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, College Station, Texas
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18
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Fisher J, Alizadeh M, Middleton D, Matias CM, Mulcahey MJ, Calhoun-Thielen C, Mohamed FB, Krisa L. Brain White Matter Abnormality Induced by Chronic Spinal Cord Injury in the Pediatric Population: A Preliminary Tract-based Spatial Statistic Study. Top Spinal Cord Inj Rehabil 2021; 27:1-13. [PMID: 34866884 DOI: 10.46292/sci20-00018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objectives: Tract-based spatial statistics (TBSS) is a diffusion tensor imaging (DTI)-based processing technique that aims to improve the objectivity and interpretability of analysis of multisubject diffusion imaging studies. This study used TBSS to measure quantitative changes in brain white matter structures following spinal cord injury (SCI). Methods: Eighteen SCI subjects aged 8-20 years old (mean age, 16.5 years) were scanned using a conventional single-shot EPI DTI protocol using a 3.0T Siemens MR scanner. All participants underwent a complete International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) examination to determine the level and severity of injury. Five participants were classified as American Spinal Injury Association Impairment Scale (AIS) A, nine as AIS B, and four as AIS C/D. Imaging parameters used for data collection were as follows: 20 directions, b = 1000 s/mm2, voxel size = 1.8 mm x 1.8 mm, slice thickness = 5 mm, TE = 95 ms, TR = 4300 ms, slices = 30, TA = 4:45 min. To generate TBSS, nonparametric permutation tests were used for voxel-wise statistical analysis of the fractional anisotropy (FA) skeletons between AIS groups. A two-tailed t test was applied to extract voxels with significant differences at p < .05. Results: Notable significant changes occurred throughout the corticospinal, spinothalamic, and dorsal column/medial lemniscus tracts. Altered regions in the temporal, occipital, and parietal lobes were also identified. Conclusion: These results suggest that white matter structures are altered differently between people with different AIS classifications. TBSS has the potential to serve as a screening tool to identify white matter changes in regions of interest.
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Affiliation(s)
- Joshua Fisher
- Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Mahdi Alizadeh
- Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.,Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Devon Middleton
- Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Caio M Matias
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - M J Mulcahey
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Feroze B Mohamed
- Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Laura Krisa
- Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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19
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Mulcahey MJ. Update From the Foundation. OTJR (Thorofare N J) 2021; 42:8-9. [PMID: 34836475 DOI: 10.1177/15394492211059406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Grampurohit N, Bell A, Duff SV, Mulcahey MJ, Thielen CC, Kaplan G, Marino RJ. Highlighting gaps in spinal cord injury research in activity-based interventions for the upper extremity: A scoping review. NeuroRehabilitation 2021; 49:23-38. [PMID: 33967071 DOI: 10.3233/nre-210042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Upper extremity activity-based therapy for neurologic disorders employs high-intensity, high repetition functional training to exploit neuroplasticity and improve function. Research focused on high-intensity upper extremity activity-based therapy for persons with spinal cord injury (SCI) is limited. OBJECTIVE To summarize high-intensity activity-based interventions used in neurological disorders for their current or potential application to SCI. METHODS The scoping review included articles from MEDLINE, CINAHL, Cochrane CENTRAL, and OTSeeker with the criteria: non-invasive activity-based interventions delivered at least three times/week for two weeks, upper extremity functional outcomes, age 13 years or older, English language, and neurological disorders three months post onset/injury. RESULTS The search yielded 172 studies. There were seven studies with SCI, all in adults. Activity-based interventions in SCI included task-specific training and gaming, with and without electrical stimulation, and a robotic exoskeleton. The other populations found in the review included studies in stroke, cerebral palsy, and multiple sclerosis. Thirty-four different interventions were reported in other populations. In comparison to the extensive stroke research, work in SCI was not found for high-intensity interventions using virtual reality, brain stimulation, rehabilitation devices, and applications to the home and telerehab settings. CONCLUSION The results highlight critical gaps within upper extremity high-intensity activity-based research in SCI.
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Affiliation(s)
- Namrata Grampurohit
- Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alison Bell
- Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Susan V Duff
- Crean College of Health and Behavioral Sciences, Chapman University, Irvine, CA, USA
| | - M J Mulcahey
- Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Gary Kaplan
- Scott Memorial Library, Academic Commons, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ralph J Marino
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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21
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Kim R, Gerhardt N, Adams M, Alpajora B, Sivori TT, Jane Mulcahey M. Spinal Cord Injury-Movement Index (SCI-MI) Fine Motor Scale: Development and Preliminary Validation. Am J Occup Ther 2021. [DOI: 10.5014/ajot.2021.75s2-po28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Date Presented 04/21/21
Most spinal cord injury (SCI) clinical trial measures do not have the capability to accurately measure recovery of movement, which creates serious problems for SCI clinical trials that have motor recovery or repair as an endpoint. Work is underway to develop a clinical trial outcome measure that is intended to evaluate recovery of neurotypical movement within the context of function. This poster presents the iterative development process of the fine motor item pool for this outcome measure.
Primary Author and Speaker: Rachel Kim
Additional Authors and Speakers: William Conrad, Dianna Lunsford, Kristin Valdes
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Affiliation(s)
- Rachel Kim
- Thomas Jefferson University, Philadelphia, PA, USA
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22
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Alpajora B, Gerhardt N, Thielen CC, Dunn W, Mulcahey MJ. Health Coaching in Context for Caregivers of Youth With Spinal Cord Injury: A Feasibility Study. Am J Occup Ther 2021. [DOI: 10.5014/ajot.2021.75s2-po97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Date Presented 04/13/21
Informal caregivers are at risk for experiencing stress, anxiety, and other concerns that influence quality of life and that have a direct effect on the care recipient. Preliminary evidence suggests that Health Coaching in Context may help address the needs of mothers who are caring for a child with spinal cord injury. Using this client-centered and solution-focused approach, OTs develop a partnership that is connected by authenticity and trust through the use of skillful, constructive dialogue.
Primary Author and Speaker: Bernadette Alpajora
Additional Authors and Speakers: Rochelle Mendonca
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Cadematori C, Alpajora B, Sivori T, Betz S, Gerhardt N, Dunn W, Mulcahey MJ. Preliminary examination of Coaching in Context with clients with spinal cord injury. Spinal Cord Ser Cases 2021; 7:27. [PMID: 33850100 PMCID: PMC8042629 DOI: 10.1038/s41394-021-00391-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 01/18/2021] [Accepted: 02/18/2021] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Repeated measures pilot study. OBJECTIVES This study examined Coaching in Context when introduced to community-dwelling adults with spinal cord injury (SCI). SETTING Urban community. METHODS Three volunteers participated in up to ten, 45-60-min Coaching in Context sessions. Number of coaching sessions was recorded. Usefulness of Coaching in Context was examined by the Canadian Occupational Performance Measure (COPM), Goal Attainment Scaling (GAS), and the Moorong Self-efficacy Scale (MSES). Data were examined descriptively. RESULTS Preliminary examination of Coaching in Context revealed successful implementation with adults with SCI living in the community. Mean COPM performance and satisfaction scores increased by 2.55 (SD = 2.25) and 4.27 (SD = 2.41), respectively. With the exception of one, each goal achieved or exceeded GAS expected level. Changed MSES scores ranged from +7 to +16. CONCLUSIONS The ability to implement and evaluate Coaching in Context with three adults with SCI was demonstrated. Improvement in goals established for coaching was also documented.
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Affiliation(s)
- Caitlin Cadematori
- Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Bernadette Alpajora
- Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Taylor Sivori
- Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Samantha Betz
- Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nicole Gerhardt
- Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - M J Mulcahey
- Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA.
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Betz S, Cadematori C, Mulcahey MJ. Thriving after pediatric spinal cord injury: two life stories. Spinal Cord Ser Cases 2021; 7:25. [PMID: 33771968 DOI: 10.1038/s41394-021-00392-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 01/29/2021] [Accepted: 02/12/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The primary objective of this qualitative study was to explore the lived experience of spinal cord injury (SCI) as described by life story interviews with two adults who sustained SCI as children. CASE PRESENTATION Data were collected by conducting 15 life story interviews with two individuals with SCI. Atkinson's Life Story Interview approach along with open-ended questions was utilized to capture the narrative data. Polkinghorne's narrative analysis of eventful data approach was used to configure the data elements into a story with the purpose of understanding the lived experience of SCI of these two individuals. Four themes relevant to the experience of living with a chronic condition emerged: adjustment to life with SCI, hardiness, interdependence, and post-traumatic growth. DISCUSSION This study illustrated how the two participants' personal development and life trajectories were deeply shaped by pediatric-onset SCI. The life story interview process proved to be an effective approach to understanding the lived experience of SCI as told by two adults with pediatric-onset SCI. While the two participants represented unique contexts, their stories conveyed several cohesive, transcendent themes relevant to the experience of living with a chronic condition. Future narrative inquiry research in individuals with pediatric-onset SCI is necessary to build a representation of this population's lived experiences.
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Affiliation(s)
- Samantha Betz
- Department of Occupational Therapy and the Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Caitlin Cadematori
- Department of Occupational Therapy and the Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - M J Mulcahey
- Department of Occupational Therapy and the Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA.
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Calhoun Thielen C, Slavin MD, Ni P, Mulcahey MJ. Development and initial validation of ability levels to interpret pediatric spinal cord injury activity measure and pediatric measure of participation scores. J Pediatr Rehabil Med 2021; 14:463-476. [PMID: 34250956 DOI: 10.3233/prm-200774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To develop ability levels and descriptions to interpret Pediatric Spinal Cord Injury Activity Measure (PEDI-SCI AM) and Pediatric Measure of Participation (PMoP) scores. METHODS Mixed-methods approach to 1.) create item maps using PEDI-SCI AM and PMoP calibration data; 2.) employ bookmarking methods and an iterative consensus process including semi-structured interviews, focus groups and surveys to establish PEDI-SCI AM and PMoP level score cut-points and descriptions; 3.) use calibration sample data to examine mean score differences across levels [analyses of variance (ANOVAs)] and assess the sample distribution (%) across levels; 4.) repeat in a separate validation sample; 5.) develop level descriptions. Throughout the mixed methods approach, the sample participants include children with spinal cord injury (SCI), parents of children with SCI, and professionals who work with children with SCI. RESULTS Four or five ability levels were identified for each PEDI-SCI AM and PMoP domain along with descriptions for each level. ANOVA results revealed significant overall differences for level mean scores and pairwise comparisons (p < 0.05). Consensus (>80%) was achieved for all PEDI-SCI AM and some PMoP level descriptions. CONCLUSION PEDI-SCI AM and PMoP score cut-points identify different levels of activity and participation among children with SCI. These levels and descriptions provide clinical relevance for PEDI-SCI and PMoP numeric scores.
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Affiliation(s)
- Christina Calhoun Thielen
- Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mary D Slavin
- Health Outcomes Unit, Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Pengsheng Ni
- Biostatistics & Epidemiology Data Analytic Center, Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - M J Mulcahey
- Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
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Rosner T, Grasso A, Scott-Cole L, Villalobos A, Mulcahey MJ. Scoping Review of School-to-Work Transition for Youth With Intellectual Disabilities: A Practice Gap. Am J Occup Ther 2020; 74:7402205020p1-7402205020p23. [PMID: 32204780 DOI: 10.5014/ajot.2019.035220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Youth with intellectual disabilities (ID) have persistently poor work outcomes. Occupational therapy can support school-to-work transition but is underrepresented in transition practice. OBJECTIVE To identify and describe interventions within the scope of occupational therapy for youth with ID who are transitioning from school to work. DATA SOURCES MEDLINE, ERIC, PsycINFO, and CINAHL were searched, and hand searching was performed in relevant peer-reviewed journals. STUDY SELECTION AND DATA COLLECTION Included were peer-reviewed, English-language articles published from 2004 to 2017 describing studies focused on youth with ID with no significant co-occurring physical diagnoses who were transitioning from U.S.-based school settings to paid employment. Data extraction was managed using Google Drive. Data were organized on extraction sheets by trained reviewers. The quality of each study was assessed using questions adapted from the Critical Appraisal Skills Program checklist. FINDINGS A total of 35 articles were included, 7 of which used randomized controlled designs. All articles described interventions aligned with the Occupational Therapy Practice Framework: Domain and Process (3rd ed.), but specific mention of occupational therapy was notably absent from the literature. Interventions had little and generally low-level evidence supporting their use. CONCLUSIONS AND RELEVANCE Significant and concerning gaps exist in the literature on school-to-work transition for youth with ID, likely impeding evidence-based practice. No included article mentioned occupational therapy or had a contributor who was an occupational therapy practitioner. Practitioners should advocate for occupational therapy's role in transition and contribute reports of occupational therapy transition services for youth with ID to the literature. WHAT THIS ARTICLE ADDS This study demonstrates that occupational therapy is poorly represented in literature describing transition services for youth with ID. Although the articles described interventions within the occupational therapy domain, these interventions were not provided by occupational therapy practitioners and did not have a strong evidence base.
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Affiliation(s)
- Taryn Rosner
- Taryn Rosner, OTD, OTR/L, is Director of Occupational Therapy, MOCO Movement Center, Kensington, MD;
| | - Anna Grasso
- Anna Grasso, MS, OTR/L, CAPS, is Academic Fieldwork Coordinator and Assistant Professor, Salus University, Elkins Park, PA
| | - Louise Scott-Cole
- Louise Scott-Cole, MSOT, OTR/L, is Occupational Therapist, Wake County Public School District, Cary, NC
| | - Alison Villalobos
- Alison Villalobos, OTD, OTR/L, is Occupational Therapist, SenseAbilities Speech and Occupational Therapy Services, Riverside, CA
| | - M J Mulcahey
- MJ Mulcahey, PhD, OTR/L, FASIA, is Professor of Occupational Therapy and Director, Center for Outcomes and Measurement, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA
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Hwang M, Zebracki K, Vogel LC, Mulcahey MJ, Varni JW. Development of the Pediatric Quality of Life Inventory™ Spinal Cord Injury (PedsQL™ SCI) module: qualitative methods. Spinal Cord 2020; 58:1134-1142. [DOI: 10.1038/s41393-020-0450-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 02/06/2023]
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Stillman M, Mallow M, Ankam N, Heckert K, Gustafson K, Mulcahey MJ, Stephens M, Verrier Piersol C, Wainwright S, Fried K. A One-Year Fellowship in the Care of People with Disabilities: A Demonstration Project. MedEdPublish 2020. [DOI: 10.15694/mep.2020.000216.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Kisala PA, Boulton AJ, Cohen ML, Slavin MD, Jette AM, Charlifue S, Hanks R, Mulcahey MJ, Cella D, Tulsky DS. Interviewer- versus self-administration of PROMIS® measures for adults with traumatic injury. Health Psychol 2019; 38:435-444. [PMID: 31045427 DOI: 10.1037/hea0000685] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To assess differential item functioning and observed mean differences across two modes of administration for PROMIS® measure scores in a sample of adults with traumatic injury. METHOD Items from 7 PROMIS® adult measures (v1.0 Physical Function, Fatigue, Pain Interference, Anger, Anxiety, and Depression and v2.0 Social Health-Emotional Support) were administered as fixed-length short forms in random order to a cross-sectional sample. Participants were randomly assigned to interviewer-administered (phone or in-person) or self-administered (via the Assessment Center website) conditions. The research was conducted at 5 medical rehabilitation institutions across the U.S. Participants included 277 adults with spinal cord injury (n = 148) or traumatic brain injury (n = 129). RESULTS DIF analyses indicated that all items were invariant to mode of administration. There was no significant effect of mode of administration for the majority of PROMIS® measures tested. Regarding observed scores, there were small but significant effects of mode of administration on the Emotional Support and Depression measures, with participants in the interview condition reporting better support/fewer symptoms. CONCLUSIONS PROMIS® instruments demonstrated measurement equivalence across interviewer-administered and self-administered conditions. These findings are particularly important for research or clinical applications where administration of PROMIS® measures by independent web- or tablet-based administration is not ideal, for example with individuals with physical or cognitive disabilities or with individuals who lack computer and/or Internet access. PROMIS® v1.0 Depression and PROMIS® v2.0 Emotional Support scores displayed a tendency toward social desirability that should be considered when these measures are interviewer-administered. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Pamela A Kisala
- Center for Health Assessment Research and Translation, College of Health Sciences, University of Delaware
| | - Aaron J Boulton
- Center for Health Assessment Research and Translation, College of Health Sciences, University of Delaware
| | - Matthew L Cohen
- Department of Communication Sciences & Disorders, College of Health Sciences, University of Delaware
| | - Mary D Slavin
- Department of Health Law, Policy and Management, Boston University School of Public Health
| | - Alan M Jette
- Massachusetts General Hospital Institute of Health Professions
| | | | - Robin Hanks
- Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine
| | - M J Mulcahey
- Department of Occupational Therapy, College of Health Professions, Thomas Jefferson University
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine
| | - David S Tulsky
- Center for Health Assessment Research and Translation, Department of Physical Therapy, College of Health Sciences, University of Delaware
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Cuddihy LA, Antonacci MD, Hussain AK, Vig KS, Mulcahey MJ, Betz RR. Progressive Neuromuscular Scoliosis Secondary to Spinal Cord Injury in a Young Patient Treated With Nonfusion Anterior Scoliosis Correction. Top Spinal Cord Inj Rehabil 2019; 25:150-156. [PMID: 31068746 DOI: 10.1310/sci2502-150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ninety-eight percent of skeletally immature patients with spinal cord injury (SCI) suffer from progressive neuromuscular scoliosis (NMS). Operative treatment has typically been limited to posterior spinal fusion (PSF), but a newer technique as described may be less invasive and preserve more function. A PSF of the entire spine to the pelvis is standard of care. However, maintenance of spinal flexibility, motion, and potential growth is desirable. We present a case for proof-of-concept of utilizing a surgical motion-preserving technique to treat progressive NMS in an 11year-old girl with T10 level (AIS B) paraplegia with a progressive 60° NMS of the lumbar spine. She had anterior scoliosis correction (ASC) from T11-L5 without fusion. Over 24 months, the curve growth-modulated to a residual of 12° with continued modulation to 7° at 3-year follow-up (skeletal maturity).
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Affiliation(s)
- Laury A Cuddihy
- Institute for Spine and Scoliosis, Lawrenceville, New Jersey
| | | | - Awais K Hussain
- Department of Orthopaedic Surgery, University of Illinois College of Medicine, Chicago, Illinois
| | - Khushdeep S Vig
- Department of Orthopedic Surgery, Albany Medical Center, Albany, New York
| | - Mary Jane Mulcahey
- Jefferson College of Rehabilitation Sciences (Philadelphia University & Thomas Jefferson University), Philadelphia, Pennsylvania
| | - Randal R Betz
- Institute for Spine and Scoliosis, Lawrenceville, New Jersey
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Behrman AL, Trimble SA, Argetsinger LC, Roberts MT, Mulcahey MJ, Clayton L, Gregg ME, Lorenz D, Ardolino EM. Interrater Reliability of the Pediatric Neuromuscular Recovery Scale for Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2019; 25:121-131. [PMID: 31068744 DOI: 10.1310/sci2502-121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: In synergy with the mounting scientific evidence for the capacity of recovery after spinal cord injury (SCI) and training, new evidence-based therapies advancing neuromuscular recovery are emerging. There is a parallel need for outcome instruments that specifically address recovery. The Pediatric Neuromuscular Recovery Scale (Pediatric NRS) is one example with established content validity to assess neuromuscular capacity within task performance. Objective: The objective of this study was to determine interrater reliability of the Pediatric NRS to classify motor capacity in children after SCI. Methods: Pediatric physicians (3), occupational therapists (5), and physical therapists (6) received standardized training in scoring the scale, then rated video assessments of 32 children post SCI, 2-12 years of age, 78% non-ambulatory. Interrater reliability was analyzed using Kendall coefficient of concordance for individual Pediatric NRS items and overall score. Results: The interrater reliability coefficient was determined to be near 1 for the overall Pediatric NRS score (ICC = 0.966; 95% CI, 0.89-0.98). Twelve of 16 individual items exhibited high concordance coefficients (Kendall's W ≥ 0.8) and four items demonstrated concordance coefficients, < 0.8 and > 0.69. Interrater reliability was equivalent among groups defined by age and neurological level, but lower among non-ambulatory individuals. Conclusion: Strong interrater reliability was demonstrated by pediatric clinicians who scored children with SCI using the Pediatric NRS.
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Affiliation(s)
- Andrea L Behrman
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky
| | - Shelley A Trimble
- Spinal Cord Medicine Program, Frazier Rehab Institute, Louisville, Kentucky
| | | | | | - M J Mulcahey
- Jefferson College of Rehabilitation Science, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lisa Clayton
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky.,Kosair Charities Center for Pediatric NeuroRecovery, University of Louisville, Louisville, Kentucky
| | - Mary E Gregg
- Department of Biostatistics, University of Louisville, Louisville, Kentucky
| | - Doug Lorenz
- Department of Biostatistics, University of Louisville, Louisville, Kentucky
| | - Elizabeth M Ardolino
- Doctor of Physical Therapy Program - Austin, University of St. Augustine for Health Sciences, Austin, Texas
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32
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Saleh E, Dahan-Oliel N, Montpetit K, Benaroch T, Yap R, Barakat N, Mulcahey MJ. Functional Gains in Children With Spastic Hemiplegia Following a Tendon Achilles Lengthening Using Computerized Adaptive Testing-A Pilot Study. Child Neurol Open 2018; 5:2329048X18811452. [PMID: 30456216 PMCID: PMC6238195 DOI: 10.1177/2329048x18811452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 08/30/2018] [Accepted: 10/14/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose: This pilot study evaluated the outcomes of tendon Achilles lengthening in 12 children (mean age: 11.2 years) with spastic hemiplegia. Methods: Cerebral Palsy Computer Adaptive Tests, the timed up-and-go, the Gross Motor Function Measure, the Gillette Functional Assessment Questionnaire, and the Pediatric Outcomes Data Collection Instrument were administered at baseline and at 6, 12, and 24 months postsurgery. Results: Significant improvement at the latest follow-up (12-24 months following surgery) was seen in all domains of the Cerebral Palsy Computer Adaptive Test: activity (P = .017), lower extremity (P = .005), global (P = .005), pain (P = .005), and fatigue (P = .028), as well as in the Gross Motor Function Measure-standing domain (P = .02) and the mobility domain of the Pediatric Outcomes Data Collection Instrument (P = .04). Conclusion: These findings indicate that the tendon Achilles lengthening improved functional outcome in these children as measured by tests of physical function, walking speed, and activity performance.
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Affiliation(s)
- Eli Saleh
- Université de Montréal, Montreal, Quebec, Canada
| | - Noémi Dahan-Oliel
- Shriners Hospital for Children, School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | | | | | - Rita Yap
- Shriners Hospital for Children, Montreal, Quebec, Canada
| | - Nadia Barakat
- Shriners Hospitals for Children, Philadelphia, PA, USA
| | - M J Mulcahey
- Shriners Hospitals for Children, Jefferson School of Health Professions, Thomas Jefferson University, Philadelphia, PA, USA
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33
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Thielen CC, Marino RJ, Duff S, Kaplan G, Mulcahey MJ. Activity-based Rehabilitation Interventions of the Neurologically Impaired Upper Extremity: Description of a Scoping Review Protocol. Top Spinal Cord Inj Rehabil 2018; 24:288-294. [PMID: 29997431 DOI: 10.1310/sci2403-288] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction: A scoping review provides a means to synthesize and present a large body of literature on a broad topic, such as methods for various upper extremity activity-based therapy (ABT) interventions. Objectives: To describe our scoping review protocol to evaluate peer-reviewed articles focused on ABT interventions for individuals with neurologically impaired upper extremities. Methods: At Jefferson College of Health Professions and Sidney Kimmel Medical College at Jefferson, Philadelphia, the authors will follow this protocol to conduct a scoping review by establishing a research question and conducting a search of bibliographic databases to identify relevant studies. Using specific inclusion and exclusion criteria, abstracts will be screened and full-text articles will be reviewed for inclusion in charting, summarizing, and reporting results of appropriate studies. Conclusion: This protocol will guide the scoping review process to develop a framework for establishing a noninvasive ABT intervention informed by evidence for individuals with neurologically impaired upper extremities.
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Affiliation(s)
- Christina Calhoun Thielen
- Jefferson College of Health Professions, Jefferson (Philadelphia University + Thomas Jefferson University), Philadelphia, Pennsylvania
| | - Ralph J Marino
- Sidney Kimmel Medical College at Jefferson (Philadelphia University + Thomas Jefferson University), Philadelphia, Pennsylvania
| | - Susan Duff
- Crean College of Health and Behavioral Sciences, Chapman University, Irvine, California
| | - Gary Kaplan
- Center for Teaching and Learning, Jefferson (Philadelphia University + Thomas Jefferson University), Philadelphia, Pennsylvania
| | - M J Mulcahey
- Jefferson College of Health Professions, Jefferson (Philadelphia University + Thomas Jefferson University), Philadelphia, Pennsylvania
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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35
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Saksena S, Mohamed FB, Middleton DM, Krisa L, Alizadeh M, Shahrampour S, Conklin CJ, Flanders A, Finsterbusch J, Mulcahey MJ, Faro SH. Diffusion Tensor Imaging Assessment of Regional White Matter Changes in the Cervical and Thoracic Spinal Cord in Pediatric Subjects. J Neurotrauma 2018; 36:853-861. [PMID: 30113265 DOI: 10.1089/neu.2018.5826] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
There are no studies to date,describing changes in the diffusion tensor imaging (DTI) metrics of the white matter (WM) regions of the entire cervical and thoracic spinal cord (SC) remote from the lesion in pediatric spinal cord injury (SCI) subjects. The purpose of this study was to determine whether DTI at sites cephalad and caudal to a lesion provides measures of cord abnormalities in children with chronic SCI. A retrospective study included 10 typically developing subjects (TD) and 10 subjects with chronic SCI who underwent SC imaging in 2014-2017. Axial diffusion tensor images using an inner field of view DTI sequence were acquired to cover the entire cervical and thoracic SC. Regions of interest were drawn on the SC WM: right and left lateral (motor), ventral (motor), and dorsal (sensory) tracts. To detect differences in DTI metrics between TD and SCI of the cord, a one way analysis of variance with pooled t test was performed. A stepwise regression analysis was performed to assess the correlation between DTI metrics and clinical scores. In motor and sensory tracts, fractional anisotropy (FA) and axial diffusivity (AD) were significantly decreased in the proximal segments of the caudal cord. In motor tracts cephalad to the lesion, FA was significantly decreased whereas AD was significantly increased in the proximal segment; however, AD was decreased in the distal and middle segments. International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) total score was significantly correlated with FA and AD of the motor and sensory tracts cephalad to the lesion. This study demonstrates that FA and AD have the potential to be sensitive biomarkers of the full extent of cord injury and might be useful in detecting remote injuries to the SC and in guiding new treatments.
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Affiliation(s)
- Sona Saksena
- 1 Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Feroze B Mohamed
- 1 Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Devon M Middleton
- 1 Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Laura Krisa
- 2 Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mahdi Alizadeh
- 1 Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania.,3 Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Shiva Shahrampour
- 4 Department of Bioengineering, Temple University, Philadelphia, Pennsylvania
| | - Chris J Conklin
- 1 Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Adam Flanders
- 1 Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jürgen Finsterbusch
- 5 Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mary Jane Mulcahey
- 2 Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Scott H Faro
- 6 Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland
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36
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Mulcahey MJ, Slavin MD, Pengsheng N, Kratz A, Kisala PA, Tulsky DS, Jette AM. Examination of psychometric properties of PROMIS®: Pediatric upper limb measures in youth with cerebral palsy. Br J Occup Ther 2018. [DOI: 10.1177/0308022618757961] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction This study examines the validity and distribution characteristics of the PROMIS® pediatric upper limb measures in a sample of young people with cerebral palsy. Method Data are a cross-sectional subset of a larger prospective study of the responsiveness to change of PROMIS® pediatric measures following surgery to improve functioning in young people with cerebral palsy. Ninety-three participants between the ages of eight and 21 years completed the PROMIS® pediatric mobility and upper limb computer adaptive tests and short forms in conjunction with a set of static “legacy” measures of physical functioning, including a parent-report of upper limb function. Results The PROMIS® Pediatric upper limb short form demonstrated acceptable internal consistency (Cronbach’s alpha = 0.85). PROMIS® pediatric upper limb computer adaptive tests and short form mean values (42.1(11) and 43(10.4), respectively) were nearly 1 SD below normal, which is appropriate when a generic measure is used in a sample of young persons with cerebral palsy. The PROMIS® pediatric upper limb computer adaptive tests had a higher frequency of ceiling effects (29.50%) compared to the short form (18.30%). Conclusion Results of this study suggest that the PROMIS® pediatric upper limb computer adaptive tests and the short form are valid indicators of upper limb function in young people with cerebral palsy. The item bank can be replenished to address ceiling effects.
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Affiliation(s)
- Mary Jane Mulcahey
- Professor of Occupational Therapy, Jefferson College of Health Professions, Thomas Jefferson University, USA
| | - Mary D Slavin
- Research Scientist, Law, Policy and Management, Boston University School of Public Health, USA
| | - Ni Pengsheng
- Statistician, Law, Policy and Management, Boston University School of Public Health, USA
| | - Anna Kratz
- Assistant Professor, Institute for Health Care Policy and Innovation, University of Michigan, USA
| | - Pamela A Kisala
- Associate Scientist, Center on Assessment Research and Translation, University of Delaware, USA
| | - David S Tulsky
- Professor, Departments of Physical Therapy and Psychological and Brain Sciences, University of Delaware, USA
| | - Alan M Jette
- Professor, Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
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37
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Alizadeh M, Fisher J, Saksena S, Sultan Y, Conklin CJ, Middleton DM, Krisa L, Finsterbusch J, Flanders AE, Faro SH, Mulcahey MJ, Mohamed FB. Age related diffusion and tractography changes in typically developing pediatric cervical and thoracic spinal cord. Neuroimage Clin 2018; 18:784-792. [PMID: 29876264 PMCID: PMC5988463 DOI: 10.1016/j.nicl.2018.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 03/02/2018] [Accepted: 03/14/2018] [Indexed: 12/14/2022]
Abstract
Background and objective Diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) are two techniques that can measure white matter integrity of the spinal cord. Recently, DTI indices have been shown to change with age. The purpose of this study is (a) to evaluate the maturational states of the entire pediatric spinal cord using DTI and DTT indices including fractional anisotropy (FA), mean diffusivity (MD), mean length of white matter fiber tracts and tract density and (b) to analyze the DTI and DTT parameters along the entire spinal cord as a function of spinal cord levels and age. Method A total of 23 typically developing (TD) pediatric subjects ranging in age from 6 to 16 years old (11.94 ± 3.26 (mean ± standard deviation), 13 females and 10 males) were recruited, and scanned using 3.0 T MR scanner. Reduced FOV diffusion tensor images were acquired axially in the same anatomical location prescribed for the T2-weighted images to cover the entire spinal cord (C1-mid L1 levels). To mitigate motion induced artifacts, diffusion directional images were aligned with the reference image (b0) using a rigid body registration algorithm performed by in-house software developed in Matlab (MathWorks, Natick, Massachusetts). Diffusion tensor maps (FA and MD) and streamline deterministic tractography were then generated from the motion corrected DTI dataset. DTI and DTT parameters were calculated by using ROIs drawn to encapsulate the whole cord along the entire spinal cord by an independent board certified neuroradiologist. These indices then were compared between two age groups (age group A = 6-11 years (n = 11) and age group B = 12-16 years (n = 12)) based on similar standards and age definitions used for reporting spinal cord injury in the pediatric population. Standard least squared linear regression based on a restricted maximum likelihood (REML) method was used to evaluate the relationship between age and DTI and DTT parameters. Results An increase in FA (group A = 0.42 ± 0.097, group B = 0.49 ± 0.116), white matter tract density (group A = 368.01 ± 236.88, group B = 440.13 ± 245.24) and mean length of fiber tracts (group A = 48.16 ± 20.48 mm, group B = 60.28 ± 23.87 mm) and a decrease in MD (group A = 1.06 ± 0.23 × 10-3 mm2/s, group B = 0.82 ± 0.24 × 10-3 mm2/s) were observed with age along the entire spinal cord. Statistically significant increases have been shown in FA (p = 0.004, R2 = 0.57), tract density (p = 0.0004, R2 = 0.58), mean length of fiber tracts (p < 0.001, R2 = 0.5) and a significant decrease has been shown in MD (p = 0.002, R2 = 0.59) between group A and group B. Also, it has been shown DTI and DTT parameters vary along the spinal cord as a function of intervertebral disk and mid-vertebral body level. Conclusion This study provides an initial understanding of age related changes of DTI values as well as DTT metrics of the spinal cord. The results show significant differences in DTI and DTT parameters which may result from decreasing water content, myelination of fiber tracts, and the thickening diameter of fiber tracts during the maturation process. Consequently, when quantitative DTI and DTT of the spinal cord is undertaken in the pediatric population an age and level matched normative dataset should be used to accurately interpret the quantitative results.
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Affiliation(s)
- Mahdi Alizadeh
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States; Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Joshua Fisher
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Sona Saksena
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Yusra Sultan
- Department of Biology, Drexel University, Philadelphia, PA, United States
| | - Chris J Conklin
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Devon M Middleton
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Laura Krisa
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, PA, United States
| | - Jürgen Finsterbusch
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Adam E Flanders
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Scott H Faro
- Department of Radiology, Johns Hopkins University, Baltimore, MD, United States
| | - M J Mulcahey
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, PA, United States
| | - Feroze B Mohamed
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States.
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38
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Mulcahey MJ, Thielen CC, Sadowsky C, Silvestri JL, Martin R, White L, Cagney JA, Vogel LC, Schottler J, Davidson L, Parry I, Taylor HB, Higgins K, Feltz ML, Sinko R, Bultman J, Mazurkiewicz J, Gaughan J. Despite limitations in content range, the SCIM-III is reproducible and a valid indicator of physical function in youths with spinal cord injury and dysfunction. Spinal Cord 2017; 56:332-340. [PMID: 29269778 DOI: 10.1038/s41393-017-0036-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 11/10/2022]
Abstract
STUDY DESIGN Multi-center, repeated measures OBJECTIVES: Evaluate psychometric properties of the SCIM-III in children. SETTING Seven facilities in North America METHODS: One-hundred and twenty-seven youths, mean age of 10.8 years and chronic spinal cord injury/dysfunction completed two administrations of the Spinal Cord Independence Measure-III (SCIM-III). Mean, standard deviation, range values were calculated for SCIM-III total and subscales for the entire sample, four age groups and injury characteristics. Test-retest reliability, concurrent validity, and floor and ceiling effects were examined. RESULTS Total SCIM-III and self-care (SC) subscale scores for the youngest age group were lower than those for the three older age groups. There were statistically significant differences in SC subscale scores between neurological level (NL) C5-T1 and T2 -T12; C5-T1 and L1-S4/5; and T2-T12 and L1-S4/5 and in in-room, and indoor/outdoor mobility subscale scores between C1-C4 and T2-T12; C1-C4 and L1-S4/5; C5-T1 and T2-T12; C5-T1 and L1-S4/5; and T2-T12 and L1-S4/5. All scores between motor complete and motor incomplete differed. Test-retest reliability was good (ICC values = > 0.84) and there was moderate to strong correlation between SCIM-III and the FIM® Instrument (r = 0.77-0.92). Ceiling effects were present in the SC subscale for the oldest age group (24%) and for NL L1-S4/5 (35.5%) and in in-room mobility subscale for 6-12 (45.7%), 13-15 (30.43%) and 16-17 (60%) ages, paraplegia (42.4%), tetraplegia (37.1%), incomplete injuries (50%), and T2-T12 (38%) and L1-S4/5 (100%) NL. CONCLUSION Despite limitations in content range, the SCIM-III is reproducible, and a valid indicator of physical functioning in youth with SCI/D 6 years of age and older. SPONSORSHIP The study was funded by the Craig H. Neilsen Foundation, Spinal Cord Injury Research on the Translation Spectrum, Senior Research Award Grant #282592 (Mulcahey, PI).
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Affiliation(s)
- M J Mulcahey
- Thomas Jefferson University, Philadelphia, PA, USA. .,Shriners Hospitals for Children, Philadelphia, PA, USA.
| | | | | | | | - Rebecca Martin
- Kennedy Krieger Rehabilitation Institute, Baltimore, MD, USA
| | - Lauren White
- Kennedy Krieger Rehabilitation Institute, Baltimore, MD, USA
| | - Julie A Cagney
- Kennedy Krieger Rehabilitation Institute, Baltimore, MD, USA
| | | | | | | | - Ingrid Parry
- Shriners Hospitals for Children, Sacramento, CA, USA
| | | | | | | | | | - Jackie Bultman
- Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, USA
| | | | - John Gaughan
- Thomas Jefferson University, Philadelphia, PA, USA
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40
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Alizadeh M, Conklin CJ, Middleton DM, Shah P, Saksena S, Krisa L, Finsterbusch J, Faro SH, Mulcahey MJ, Mohamed FB. Identification of ghost artifact using texture analysis in pediatric spinal cord diffusion tensor images. Magn Reson Imaging 2017; 47:7-15. [PMID: 29154897 DOI: 10.1016/j.mri.2017.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 11/11/2017] [Accepted: 11/13/2017] [Indexed: 01/18/2023]
Abstract
PURPOSE Ghost artifacts are a major contributor to degradation of spinal cord diffusion tensor images. A multi-stage post-processing pipeline was designed, implemented and validated to automatically remove ghost artifacts arising from reduced field of view diffusion tensor imaging (DTI) of the pediatric spinal cord. METHOD A total of 12 pediatric subjects including 7 healthy subjects (mean age=11.34years) with no evidence of spinal cord injury or pathology and 5 patients (mean age=10.96years) with cervical spinal cord injury were studied. Ghost/true cords, labeled as region of interests (ROIs), in non-diffusion weighted b0 images were segmented automatically using mathematical morphological processing. Initially, 21 texture features were extracted from each segmented ROI including 5 first-order features based on the histogram of the image (mean, variance, skewness, kurtosis and entropy) and 16s-order feature vector elements, incorporating four statistical measures (contrast, correlation, homogeneity and energy) calculated from co-occurrence matrices in directions of 0°, 45°, 90° and 135°. Next, ten features with a high value of mutual information (MI) relative to the pre-defined target class and within the features were selected as final features which were input to a trained classifier (adaptive neuro-fuzzy interface system) to separate the true cord from the ghost cord. RESULTS The implemented pipeline was successfully able to separate the ghost artifacts from true cord structures. The results obtained from the classifier showed a sensitivity of 91%, specificity of 79%, and accuracy of 84% in separating the true cord from ghost artifacts. CONCLUSION The results show that the proposed method is promising for the automatic detection of ghost cords present in DTI images of the spinal cord. This step is crucial towards development of accurate, automatic DTI spinal cord post processing pipelines.
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Affiliation(s)
- Mahdi Alizadeh
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States; Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United States.
| | - Chris J Conklin
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Devon M Middleton
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Pallav Shah
- Department of Radiology, Temple University, Philadelphia, PA, United States
| | - Sona Saksena
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Laura Krisa
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, PA, United States
| | - Jürgen Finsterbusch
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Scott H Faro
- Department of Radiology, Johns Hopkins University, Baltimore, MD, United States
| | - M J Mulcahey
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, PA, United States
| | - Feroze B Mohamed
- Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, Philadelphia, PA, United States
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41
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Krogh K, Emmanuel A, Perrouin-Verbe B, Korsten MA, Mulcahey MJ, Biering-Sørensen F. International spinal cord injury bowel function basic data set (Version 2.0). Spinal Cord 2017; 55:692-698. [PMID: 28195229 DOI: 10.1038/sc.2016.189] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 12/06/2016] [Accepted: 12/11/2016] [Indexed: 01/06/2023]
Abstract
STUDY DESIGN International expert working group. OBJECTIVES To revise the International Spinal Cord Injury (SCI) Bowel Function Basic Data Set as a standardized format for the collecting and reporting of a minimal amount of information on bowel function in clinical practice and research. SETTING Working group appointed by the American Spinal injury association (ASIA) and the International Spinal Cord Society (ISCoS). METHODS The draft prepared by the working group was reviewed by the International SCI Data Set Committee and later by members of the ISCoS Executive and Scientific Committees and the ASIA board. The revised data set was posted on the ASIA and ISCoS websites for 1 month to allow further comments and suggestions. Changes resulting from a Delphi process among experts in children with SCI were included. Members of ISCoS Executive and Scientific Committees and the ASIA board made a final review and approved the data set. RESULTS The International SCI Bowel Function Basic Data Set (Version 2.0) consists of the following 16 items: date of data collection, gastrointestinal and anal sphincter dysfunction unrelated to SCI, surgical procedures on the gastrointestinal tract, defecation method and bowel-care procedures, average time required for defecation, frequency of defecation, uneasiness, headache or perspiration during defecation, digital stimulation or evacuation of the anorectum, frequency of fecal incontinence, flatus incontinence, need to wear pad or plug, oral laxatives and prokinetics, anti-diarrheal agents, perianal problems, abdominal pain and discomfort and the neurogenic bowel dysfunction score. CONCLUSION The International SCI Bowel Function Basic Data Set (Version 2.0) has been developed.
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Affiliation(s)
- K Krogh
- Department of Hepatology and Gastroenterology, Neurogastroenterology Unit, Aarhus University Hospital, Aarhus, Denmark
| | - A Emmanuel
- GI Physiology Unit, University College Hospital, London, UK
| | - B Perrouin-Verbe
- Department of Physical Medicine and Rehabilitation, St Jacques Hospital, University Hospital of Nantes, Nantes, France
| | - M A Korsten
- Department of Medicine, Ichan School of Medicine, Mount Sinai and James J Peters VA Medical Center, Bronx, NY, USA.,VA National Center for the Medical Consequences of Spinal Cord Injury, Bronx, NY, USA
| | - M J Mulcahey
- Department of Occupational Therapy, Thomas Jefferson University, Jefferson College of Health Professions, Philadelphia, PA, USA
| | - F Biering-Sørensen
- Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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42
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Coster WJ, Ni P, Slavin MD, Kisala PA, Nandakumar R, Mulcahey MJ, Tulsky DS, Jette AM. Differential item functioning in the Patient Reported Outcomes Measurement Information System Pediatric Short Forms in a sample of children and adolescents with cerebral palsy. Dev Med Child Neurol 2016; 58:1132-1138. [PMID: 27098277 PMCID: PMC5052096 DOI: 10.1111/dmcn.13138] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2016] [Indexed: 11/30/2022]
Abstract
AIM The present study examined the Patient Reported Outcomes Measurement Information System (PROMIS) Mobility, Fatigue, and Pain Interference Short Forms (SFs) in children and adolescents with cerebral palsy (CP) for the presence of differential item functioning (DIF) relative to the original calibration sample. METHOD Using the Graded Response Model we compared item parameter estimates generated from a sample of 303 children and adolescents with CP (175 males, 128 females; mean age 15y 5mo) to parameter estimates from the PROMIS calibration sample, which served as the reference group. DIF was assessed in a two-step process using the item response theory-likelihood ratio-differential item functioning detection procedure. RESULTS Significant DIF was identified for four of eight items in the PROMIS Mobility SF, for two of eight items in the Pain Interference Scale, and for one item out of 10 on the Fatigue Scale. Impact of DIF on total score estimation was notable for Mobility and Pain Interference, but not for Fatigue. INTERPRETATION Results suggest differences in the responses of adolescents with CP to some items on the PROMIS Mobility and Pain Interference SFs. Cognitive interviews about the PROMIS items with adolescents with varying degrees of mobility limitations would provide better understanding of how they are interpreting and selecting responses to the PROMIS items and thus help guide selection of the most appropriate way to address this issue.
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Affiliation(s)
- Wendy J Coster
- Department of Occupational Therapy, Boston University College of Health and Rehabilitation Sciences: Sargent College, Boston, MA, USA.
| | - Pengsheng Ni
- Health and Disability Research Institute, Boston University School of Public Health, Boston, MA
| | - Mary D Slavin
- Health and Disability Research Institute, Boston University School of Public Health, Boston, MA
| | - Pamela A Kisala
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE
| | - Ratna Nandakumar
- College of Education and Human Development, University of Delaware, Newark, DE
| | - Mary Jane Mulcahey
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, PA
| | - David S Tulsky
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE,Kessler Foundation Research Center, West Orange, NJ, USA
| | - Alan M Jette
- Health and Disability Research Institute, Boston University School of Public Health, Boston, MA
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43
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Calhoun Thielen C, Sadowsky C, Vogel LC, Taylor H, Davidson L, Bultman J, Gaughan J, Mulcahey MJ. Evaluation of the Walking Index for Spinal Cord Injury II (WISCI-II) in children with Spinal Cord Injury (SCI). Spinal Cord 2016; 55:478-482. [DOI: 10.1038/sc.2016.142] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/12/2016] [Accepted: 09/14/2016] [Indexed: 11/09/2022]
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Mulcahey MJ, Haley SM, Slavin MD, Kisala PA, Ni P, Tulsky DS, Jette AM. Ability of PROMIS Pediatric Measures to Detect Change in Children With Cerebral Palsy Undergoing Musculoskeletal Surgery. J Pediatr Orthop 2016; 36:749-56. [PMID: 26057065 PMCID: PMC4670604 DOI: 10.1097/bpo.0000000000000533] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Patient Reported Outcomes Measurement Information System (PROMIS) was developed to provide patient-reported outcome measures that are designed as being universally relevant across health conditions, low burden, and precise. A major problem for research and clinical practice in cerebral palsy (CP) is the void of outcomes instruments that are capable of evaluating the wide range of abilities and broad age spectrum inherent in this clinical population. Given the tremendous potential of PROMIS, the research questions for this study were "How do PROMIS pediatric computer adaptive tests and short forms detect change in children with CP following elective musculoskeletal surgery?" and "How do PROMIS instruments compare to the Pediatric Quality of Life Inventory Cerebral Palsy Module Version 3.0 (PedsQL CP), Pediatric Outcomes Data Collection Instrument (PODCI), the Timed Up and Go (TUG), and the Gross Motor Functional Measure (GMFM)." METHODS PROMIS Pediatric computer adaptive tests and short forms and the PedsQL, PODCI, TUG, and GMFM were administered before and after surgery. Effect size (ES) and standardized response mean (SRM) were calculated. Floor and ceiling effects were evaluated and, exposure rates for the PROMIS item banks were examined. RESULTS ES and SRM for all PROMIS Pediatric Measures were nonsignificant. PedsQL CP detected significant, positive change in mobility at 6 (ES=0.26; SRM=0.31) and 12 (ES=0.36; SRM=0.36) months; pain at 12 months (ES=0.29; SRM=0.34); and fatigue at 6 (ES=0.24; SRM=0.22) and 12 (ES=0.36; SRM=0.41) months. Significant negative changes were detected by the PODCI (ES=-0.20; SRM=-0.26), GMFM (ES=-0.13; SRM=-0.24), and TUG (ES=-0.29; SRM=-0.25). Ceiling effects were high. Exposure to an appropriate range of the PROMIS Mobility item bank was limited. CONCLUSIONS PROMIS measures were less able to detect change than other measures. PROMIS measures may be improved by tailoring start/stop rules or by adding items to include content appropriate for children with mobility impairments. LEVEL OF EVIDENCE Level III-diagnostic study.
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Affiliation(s)
- MJ Mulcahey
- Department of Occupational Therapy, School of Health Professions, Thomas Jefferson University, Philadelphia, PA
| | - Stephen M. Haley
- Boston University School of Public Health, Health and Disability Research Institute, Boston, MA
- Deceased
| | - Mary D. Slavin
- Boston University School of Public Health, Health and Disability Research Institute, Boston, MA
| | - Pamela A. Kisala
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE
| | - Pengsheng Ni
- Boston University School of Public Health, Health and Disability Research Institute, Boston, MA
| | - David S. Tulsky
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE
- Kessler Foundation Research Center, West Orange, NJ
| | - Alan M. Jette
- Boston University School of Public Health, Health and Disability Research Institute, Boston, MA
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Saksena S, Middleton DM, Krisa L, Shah P, Faro SH, Sinko R, Gaughan J, Finsterbusch J, Mulcahey MJ, Mohamed FB. Diffusion Tensor Imaging of the Normal Cervical and Thoracic Pediatric Spinal Cord. AJNR Am J Neuroradiol 2016; 37:2150-2157. [PMID: 27418470 DOI: 10.3174/ajnr.a4883] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 05/23/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE DTI data of the normal healthy spinal cord in children are limited compared with adults and are typically focused on the cervical spinal cord. The purpose of this study was the following: to investigate the feasibility of obtaining repeatable DTI parameters along the entire cervical and thoracic spinal cord as a function of age in typically developing pediatric subjects; to analyze the DTI parameters among different transverse levels of the cervical and thoracic spinal cord; and to examine the sex differences in DTI parameters along the cervical and thoracic spinal cord. MATERIALS AND METHODS Twenty-two subjects underwent 2 identical scans by using a 3T MR imaging scanner. Axial diffusion tensor images were acquired by using 2 overlapping slabs to cover the cervical and thoracic spinal cord. After postprocessing, DTI parameters were calculated by using ROIs drawn on the whole cord along the entire spinal cord for both scans. RESULTS An increase in fractional anisotropy and a decrease in mean diffusivity, axial diffusivity, and radial diffusivity were observed with age along the entire spinal cord. Significantly lower fractional anisotropy and higher mean diffusivity values were observed in the lower cervical cord compared with the upper cervical cord. Axial diffusivity values in the cervical cord were higher compared with the thoracic cord. No statistically significant sex differences were observed for all DTI parameters. There was a moderate-to-strong repeatability for all DTI parameters. CONCLUSIONS This study provides an initial understanding of DTI values of the spinal cord relevant to age and sex and shows that obtaining repeatable DTI values of the entire cord in children is feasible.
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Affiliation(s)
- S Saksena
- From the Departments of Radiology (S.S., F.B.M.)
| | - D M Middleton
- Department of Radiology (D.M.M., P.S., S.H.F.), Temple University, Philadelphia, Pennsylvania
| | - L Krisa
- Occupational Therapy (L.K., R.S., M.J.M.), Thomas Jefferson University, Philadelphia, Pennsylvania
| | - P Shah
- Department of Radiology (D.M.M., P.S., S.H.F.), Temple University, Philadelphia, Pennsylvania
| | - S H Faro
- Department of Radiology (D.M.M., P.S., S.H.F.), Temple University, Philadelphia, Pennsylvania
| | - R Sinko
- Occupational Therapy (L.K., R.S., M.J.M.), Thomas Jefferson University, Philadelphia, Pennsylvania
| | - J Gaughan
- Biostatistics Consulting Center (J.G.), Temple University School of Medicine, Philadelphia, Pennsylvania
| | - J Finsterbusch
- Department of Systems Neuroscience (J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M J Mulcahey
- Occupational Therapy (L.K., R.S., M.J.M.), Thomas Jefferson University, Philadelphia, Pennsylvania
| | - F B Mohamed
- From the Departments of Radiology (S.S., F.B.M.)
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Slavin MD, Mulcahey MJ, Calhoun C, Ni P, Vogel LC, Haley SM, Jette AM. Measuring activity limitation outcomes in youth with spinal cord injury. Spinal Cord 2016; 54:546-52. [PMID: 26572606 PMCID: PMC4870166 DOI: 10.1038/sc.2015.194] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 09/02/2015] [Accepted: 09/24/2015] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN A cross-sectional study. OBJECTIVES The Pediatric Spinal Cord Injury Activity Measure (PEDI-SCI AM), which includes calibrated item banks (child and parent versions) for general mobility, daily routines, wheeled mobility and ambulation, can be administered using computerized adaptive tests (CATs) or short forms (SFs). The study objectives are as follows: (1) to examine the psychometric properties of the PEDI-SCI AM item banks and 10-item CATs; and (2) to develop and evaluate the psychometric properties of PEDI-SCI AM SFs. SETTING US Shriners Hospitals for Children (California, Illinois and Pennsylvania). METHODS Calibration data from a convenience sample of 381 children and adolescents with SCI and 322 parents or caregivers were used to examine PEDI-SCI AM item banks, 10-item CATs and SF scores. We calculated group reliability, internal consistency (Cronbach's alpha) and interclass coefficients (ICCs) to assess agreement between 10-item CATs, SFs and item banks. The percent of the sample with highest (ceiling) and lowest (floor) scores was also determined. An expert panel selected items for 14 SFs. RESULTS PEDI-SCI item banks, 10-item CATs and SFs demonstrate acceptable group reliability (0.73-0.96) and internal consistency (0.77-0.98). ICC values show strong agreement with item banks for 10-item CATs (0.72-0.99) and SFs. Floor effects are minimal (<15%). Ceiling effects are minimal for children with tetraplegia but high in children with paraplegia for general mobility (13.41-26.05%) and daily activities (12.99-32.71%). CONCLUSIONS The PEDI-SCI AM exhibited strong psychometric properties for children with tetraplegia. Replenishment of the general mobility and daily routine item banks is needed to reduce ceiling effects noted for youth with paraplegia.
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Affiliation(s)
- Mary D. Slavin
- Health and Disability Research Institute, Boston
University School of Public Health, Boston, MA
| | - MJ Mulcahey
- Department of Occupational Therapy, Jefferson College of
Health Professions, Thomas Jefferson University, Philadelphia, PA
- Shriners Hospitals for Children, Philadelphia, PA
| | - Christina Calhoun
- Department of Occupational Therapy, Jefferson College of
Health Professions, Thomas Jefferson University, Philadelphia, PA
| | - Pengsheng Ni
- Health and Disability Research Institute, Boston
University School of Public Health, Boston, MA
| | | | - Stephen M. Haley
- Health and Disability Research Institute, Boston
University School of Public Health, Boston, MA
| | - Alan M. Jette
- Health and Disability Research Institute, Boston
University School of Public Health, Boston, MA
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47
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Mulcahey MJ, Slavin MD, Ni P, Vogel LC, Thielen CC, Coster WJ, Jette AM. The Pediatric Measure of Participation (PMoP) short forms. Spinal Cord 2016; 54:1183-1187. [DOI: 10.1038/sc.2016.68] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/14/2016] [Accepted: 03/30/2016] [Indexed: 11/09/2022]
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Conklin CJ, Middleton DM, Alizadeh M, Finsterbusch J, Raunig DL, Faro SH, Shah P, Krisa L, Sinko R, Delalic JZ, Mulcahey MJ, Mohamed FB. Spatially selective 2D RF inner field of view (iFOV) diffusion kurtosis imaging (DKI) of the pediatric spinal cord. Neuroimage Clin 2016; 11:61-67. [PMID: 26909329 PMCID: PMC4735660 DOI: 10.1016/j.nicl.2016.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/24/2015] [Accepted: 01/09/2016] [Indexed: 11/24/2022]
Abstract
Magnetic resonance based diffusion imaging has been gaining more utility and clinical relevance over the past decade. Using conventional echo planar techniques, it is possible to acquire and characterize water diffusion within the central nervous system (CNS); namely in the form of Diffusion Weighted Imaging (DWI) and Diffusion Tensor Imaging (DTI). While each modality provides valuable clinical information in terms of the presence of diffusion and its directionality, both techniques are limited to assuming an ideal Gaussian distribution for water displacement with no intermolecular interactions. This assumption neglects pathological processes that are not Gaussian therefore reducing the amount of potentially clinically relevant information. Additions to the Gaussian distribution measured by the excess kurtosis, or peakedness, of the probabilistic model provide a better understanding of the underlying cellular structure. The objective of this work is to provide mathematical and experimental evidence that Diffusion Kurtosis Imaging (DKI) can offer additional information about the micromolecular environment of the pediatric spinal cord. This is accomplished by a more thorough characterization of the nature of random water displacement within the cord. A novel DKI imaging sequence based on a tilted 2D spatially selective radio frequency pulse providing reduced field of view (FOV) imaging was developed, implemented, and optimized on a 3 Tesla MRI scanner, and tested on pediatric subjects (healthy subjects: 15; patients with spinal cord injury (SCI):5). Software was developed and validated for post processing of the DKI images and estimation of the tensor parameters. The results show statistically significant differences in mean kurtosis (p < 0.01) and radial kurtosis (p < 0.01) between healthy subjects and subjects with SCI. DKI provides incremental and novel information over conventional diffusion acquisitions when coupled with higher order estimation algorithms. Diffusion Kurtosis Imaging (DKI) was performed on pediatric subjects using a tilted 2D RF reduced field of view sequence. Results show statistically significant differences in FA, MK, Krad, and Drad between healthy subjects and patients with SCI. DKI provides additional structural information that when paired with DTI metrics could be used as a novel imaging biomarker.
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Affiliation(s)
- Chris J Conklin
- Electrical Engineering, Temple University, Philadelphia, PA, United States; Radiology, Thomas Jefferson University, Philadelphia, PA, United States.
| | - Devon M Middleton
- Radiology, Temple University, Philadelphia, PA, United States; Bioengineering, Temple University, Philadelphia, PA, United States
| | - Mahdi Alizadeh
- Radiology, Temple University, Philadelphia, PA, United States; Bioengineering, Temple University, Philadelphia, PA, United States
| | - Jürgen Finsterbusch
- Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Scott H Faro
- Radiology, Temple University, Philadelphia, PA, United States; Bioengineering, Temple University, Philadelphia, PA, United States
| | - Pallav Shah
- Radiology, Temple University, Philadelphia, PA, United States
| | - Laura Krisa
- Physical Therapy, Thomas Jefferson University, Philadelphia, PA, United States; Occupational Therapy, Thomas Jefferson University, Philadelphia, PA, United States
| | - Rebecca Sinko
- Occupational Therapy, Thomas Jefferson University, Philadelphia, PA, United States
| | - Joan Z Delalic
- Electrical Engineering, Temple University, Philadelphia, PA, United States
| | - M J Mulcahey
- Occupational Therapy, Thomas Jefferson University, Philadelphia, PA, United States
| | - Feroze B Mohamed
- Bioengineering, Temple University, Philadelphia, PA, United States; Radiology, Thomas Jefferson University, Philadelphia, PA, United States
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Ardolino EM, Mulcahey MJ, Trimble S, Argetsinger L, Bienkowski M, Mullen C, Behrman AL. Development and Initial Validation of the Pediatric Neuromuscular Recovery Scale. Pediatr Phys Ther 2016; 28:416-426. [PMID: 27428576 DOI: 10.1097/pep.0000000000000285] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE The Neuromuscular Recovery Scale (NRS) was developed to assess the capacity of adults' post-spinal cord injury (SCI) to perform functional tasks without compensation. Application of the NRS to children has been challenging. The purpose of this study was to develop and complete the initial validation of a pediatric version of the NRS. METHODS First, the investigative team developed a draft Pediatric NRS. Next, a Delphi method was used to amend the draft by 12 pediatric experts. Finally, the revised Pediatric NRS was field-tested on a sample of children with SCI (n = 5) and without (n = 7). RESULTS After the Delphi process and field testing, the Pediatric NRS consists of 13 items scored on a 12-point scale. All items, except 1, achieved 80% agreement by experts. CONCLUSIONS This is the first step in development and validation of a pediatric SCI scale that evaluates neuromuscular capacity, in the context of pediatric function, without compensation.
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Affiliation(s)
- Elizabeth M Ardolino
- Doctor of Physical Therapy Program-Austin (Dr Ardolino), University of St. Augustine for Health Sciences, Austin, Texas; Jefferson School of Health Professions (Dr Mulcahey), Thomas Jefferson University, Philadelphia, Pennsylvania; Kosair Charities Center for Pediatric NeuroRecovery (Ms Trimble and Dr Argetsinger), Frazier Rehab Institute, Louisville, Kentucky; Shriners Hospitals for Children (Drs Bienkowski and Mullen), Philadelphia, Pennsylvania; and Department of Neurological Surgery (Dr Behrman), University of Louisville, Louisville, Kentucky
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Barakat N, Shah P, Faro SH, Gaughan JP, Middleton D, Mulcahey MJ, Mohamed FB. Inter- and intra-rater reliability of diffusion tensor imaging parameters in the normal pediatric spinal cord. World J Radiol 2015; 7:279-85. [PMID: 26435778 PMCID: PMC4585951 DOI: 10.4329/wjr.v7.i9.279] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 06/24/2015] [Accepted: 07/29/2015] [Indexed: 02/06/2023] Open
Abstract
AIM To assess inter- and intra-rater reliability (agreement) between two region of interest (ROI) methods in pediatric spinal cord diffusion tensor imaging (DTI). METHODS Inner-Field-of-View DTI data previously acquired from ten pediatric healthy subjects (mean age = 12.10 years) was used to assess for reliability. ROIs were drawn by two neuroradiologists on each subject data twice within a 3-mo interval. ROIs were placed on axial B0 maps along the cervical spine using free-hand and fixed-size ROIs. Agreement analyses for fractional anisotropy (FA), axial diffusivity, radial diffusivity and mean diffusivity were performed using intra-class-correlation (ICC) and Cronbach's alpha statistical methods. RESULTS Inter- and intra-rater agreement between the two ROI methods showed moderate (ICC = 0.5) to strong (ICC = 0.84). There were significant differences between raters in the number of pixels selected using free-hand ROIs (P < 0.05). However, no significant differences were observed in DTI parameter values. FA showed highest variability in ICC values (0.10-0.87). Cronbach's alpha showed moderate-high values for raters and ROI methods. CONCLUSION The study showed that high reproducibility in spinal cord DTI can be achieved, and demonstrated the importance of setting detailed methodology for post-processing DTI data, specifically the placement of ROIs.
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