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Liu N, Xing H, Zhou M, Biering-Sørensen F. Lack of knowledge and training are the major obstacles in application of the Spinal Cord Independence Measure (SCIM) in China. J Spinal Cord Med 2019; 42:437-443. [PMID: 29595400 PMCID: PMC6718138 DOI: 10.1080/10790268.2018.1454021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE To investigate the use of functional outcome measurements after spinal cord injury (SCI) in current clinical practice and to explore the knowledge about the Spinal Cord Independence Measure (SCIM) among SCI physicians in China, and to find facilitators for a broader utilization of SCIM. DESIGN A survey-based study. SETTING SCI workshops at Peking University. PARTICIPANTS 125 Chinese SCI physicians attending annual workshops in two consecutive years. INTERVENTIONS Not applicable. OUTCOME MEASURES A questionnaire was administered. The following items were included: whether functional outcome measurement for SCI individuals was performed and with which assessment tool(s); what items should be included in the assessment; whether they knew about the SCIM, its latest version, the Chinese translation, and if so from what source; the possible reasons why SCIM was not implemented in clinical practice; and whether training before using the SCIM was needed, and the training method preferred. RESULTS Among these physicians, 84.8% performed functional outcome measurement for individuals with SCI, but only 29.6% of attendees were aware of the SCIM and 20.8% had used it. Lack of training was the major reason why SCIM was not used in clinical practice. Furthermore, 74.4% of the physicians felt they needed formal training before using the SCIM. CONCLUSION The use of SCIM is limited in clinical practice in China, which is mainly attributed to lack of knowledge and training. Formal training on the use of the SCIM is essential for its dissemination and will improve functional SCI outcome measurement in China.
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Affiliation(s)
- Nan Liu
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Huayi Xing
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Mouwang Zhou
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China,Correspondence to: Professor Mouwang Zhou, Department of Rehabilitation Medicine, Peking UniversityThird Hospital, No. 49 North Garden Road, Beijing, China, 100191; Ph: +86 (10) 8226-6688, Fax: +86 (10) 8226-5861.
| | - Fin Biering-Sørensen
- Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Using a logarithmic model to predict functional independence after spinal cord injury: a retrospective study. Spinal Cord 2019; 57:1048-1056. [DOI: 10.1038/s41393-019-0315-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/02/2019] [Accepted: 06/03/2019] [Indexed: 11/09/2022]
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Jaja BNR, Jiang F, Badhiwala JH, Schär R, Kurpad S, Grossman RG, Harrop JS, Guest JD, Toups EG, Shaffrey CI, Aarabi B, Boakye M, Fehlings MG, Wilson JR. Association of Pneumonia, Wound Infection, and Sepsis with Clinical Outcomes after Acute Traumatic Spinal Cord Injury. J Neurotrauma 2019; 36:3044-3050. [PMID: 31007137 DOI: 10.1089/neu.2018.6245] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
< 0.001). There were no statistical differences between participants with or without PWS with respect to time from injury to surgery, and administration of steroids. Dominance analysis showed injury level, baseline AIS grade, and subject pre-morbid medical status collectively accounted for 77.7% of the predicted variance of PWS. Regression analysis indicated subjects with PWS demonstrated higher odds for respiratory (odds ratio [OR] 3.91, 95% confidence interval [CI]: 1.42-10.79) and ambulatory (OR 3.94, 95% CI: 1.50-10.38) support at 6 month follow-up in adjusted analysis. This study has shown an association between PWS occurring during acute admission and poorer functional outcomes following SCI.
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Affiliation(s)
- Blessing N R Jaja
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada.,Division of Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Fan Jiang
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Jetan H Badhiwala
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ralph Schär
- Division of Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Shekar Kurpad
- Division of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - James S Harrop
- Division of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jim D Guest
- Division of Neurosurgery, University of Miami, Miami, Florida
| | | | - Chris I Shaffrey
- Division of Neurosurgery, University of Virginia, Chalottesville, Virginia
| | - Bizhan Aarabi
- Division of Neurosurgery, Shock Trauma, University of Maryland, Baltimore, Maryland
| | - Max Boakye
- Division of Neurosurgery, University of Louisville, Louisville, Kentucky
| | - Michael G Fehlings
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jefferson R Wilson
- Division of Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Scivoletto G, Galli G, Torre M, Molinari M, Pazzaglia M. The Overlooked Outcome Measure for Spinal Cord Injury: Use of Assistive Devices. Front Neurol 2019; 10:272. [PMID: 30967836 PMCID: PMC6438886 DOI: 10.3389/fneur.2019.00272] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 02/28/2019] [Indexed: 12/12/2022] Open
Abstract
Although several outcome measures are used to assess various areas of interest regarding spinal cord injuries (SCIs), little is known about the frequency of their use, and the ways in which they transform shared knowledge into implemented practices. Herein, 800 professionals from the International Spinal Cord Society, especially trained for caring in patients with SCI, were invited to respond to an Internet survey collecting information on the use of standardized measures in daily clinical practices. We asked both clinicians and researchers with different areas of interest about their use of functional outcome measures, and, in particular, which scales they habitually use to assess various aspects of clinical practice and rehabilitation. We selected a set of rating scales, which were validated for measuring SCIs (http://www.scireproject.com/outcome-measures). The results show that the areas of interest assessed by most of the participants were neurological status, upper limb, lower limb gait, pain, spasticity, self-care, and daily living. The most widely used rating scales were the spinal cord independence measure, the functional independence measure and the International Standards for Neurological Classification of Spinal Cord Injury. Instead, the majority of respondents did not evaluate the use of assistive technology. Despite the availability of several outcome scales, the practice of evaluating SCIs with standardized measures for assistive technologies and wheelchair mobility is still not widespread, even though it is a high priority in the rehabilitation of SCI patients. The results emphasize the need for a more thorough knowledge and use of outcome scales, thus improving the quality of assistive device evaluation.
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Affiliation(s)
- Giorgio Scivoletto
- Spinal Cord Unit, IRCCS Fondazione Santa Lucia, Rome, Italy.,Spinal Rehabilitation Lab, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Giulia Galli
- Spinal Cord Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Monica Torre
- Spinal Cord Unit, IRCCS Fondazione Santa Lucia, Rome, Italy.,Spinal Rehabilitation Lab, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Marco Molinari
- Spinal Cord Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Mariella Pazzaglia
- Spinal Cord Unit, IRCCS Fondazione Santa Lucia, Rome, Italy.,Department of Psychology, La Sapienza University of Rome, Rome, Italy
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So C, Lage DE, Slocum CS, Zafonte RD, Schneider JC. Utility of Functional Metrics Assessed During Acute Care on Hospital Outcomes: A Systematic Review. PM R 2019; 11:522-532. [PMID: 30758920 PMCID: PMC10108704 DOI: 10.1002/pmrj.12013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/10/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Traditionally, illness severity, social factors, and comorbid conditions have been examined as predictors of hospital outcomes. However, recent research in the rehabilitation setting demonstrated that physical function outperformed comorbidity indices as a predictor of 30-day readmission. The purpose of this study was to review the literature examining the association between acute hospital physical function and various hospital outcomes and health care utilization. TYPE: Systematic review. LITERATURE SURVEY A review of the MEDLINE database was performed. Search terms included acute functional outcomes and frailty outcomes. Studies up to September 2017 were included if they were in English and examined how functional metrics collected at acute care hospitalization affected hospital outcomes. METHODOLOGY Cohort characteristics and measures of associations were extracted from the studies. Outcomes include hospital readmission, length of stay, mortality, discharge location, and physical function post acute care. The studies were assessed for potential confounders as well as selection, attrition, and detection bias. SYNTHESIS A total of 30 studies were identified (hospital readmissions: 6; discharge location: 11; length of stay: 4; mortality: 15; function: 6). Thirteen different metrics assessed function during acute care. Lower function during acute care was associated with statistically significant higher odds of hospital readmission, lower likelihood of discharge to home, longer hospital length of stay, increased mortality, and worse functional recovery when compared to patients with higher function during acute care, when adjusted for age and gender. The Barthel Index may be a useful marker for mortality in the elderly whereas the Functional Independence Measure instrument may be valuable for examining discharge location. CONCLUSIONS There is increasing evidence that function measured during acute care predicts a broad array of meaningful clinical outcomes. Further research would help direct the use of practical, yet parsimonious functional metrics that effectively screen high-need, high-cost patients to deliver optimal care. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Conan So
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA.,University of Maryland School of Medicine, Baltimore, MD
| | - Daniel E Lage
- Department of Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Chloe S Slocum
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Ross D Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA.,Department of Medicine, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA.,Harvard Medical School, Boston, MA
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Sahib S, Niu F, Sharma A, Feng L, Tian ZR, Muresanu DF, Nozari A, Sharma HS. Potentiation of spinal cord conduction and neuroprotection following nanodelivery of DL-3-n-butylphthalide in titanium implanted nanomaterial in a focal spinal cord injury induced functional outcome, blood-spinal cord barrier breakdown and edema formation. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2019; 146:153-188. [DOI: 10.1016/bs.irn.2019.06.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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57
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Quinzaños-Fresnedo J, Fratini-Escobar PC, Almaguer-Benavides KM, Aguirre-Güemez AV, Barrera-Ortíz A, Pérez-Zavala R, Villa-Romero AR. Prognostic validity of a clinical trunk control test for independence and walking in individuals with spinal cord injury. J Spinal Cord Med 2018; 43:331-338. [PMID: 30207875 PMCID: PMC7241519 DOI: 10.1080/10790268.2018.1518124] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Objective: The objective of the present work was to determine the prognostic validity of the trunk control test for walking and independence in individuals with SCI.Design: A cohort, prospective study was carried out in all individuals with sub-acute SCI.Setting: All inpatients at the Mexico City based National Rehabilitation Institute (INR).Participants: Ninety individuals with a clinical diagnosis of sub-acute SCI, American Spinal Injury Association Impairment Scale (AIS) A-D, and that have not participated in a rehabilitation program were included. Thirty-five individuals had good initial trunk control and the remaining 55 had poor trunk control. All individuals participated in a standard rehabilitation program subsequently.Interventions: N/AOutcome Measures: The trunk control test was performed at baseline. At 1, 3, 6, 9 and 12 months after the first evaluation, walking and independence were assessed.Results: Survival Analysis revealed that 62.5% and 100% individuals with good trunk control at baseline assessment were respectively walking and independent in ADL at 12 months and 14% and 48% individuals with poor trunk control were walking and independent in ADL. Cox regression analysis revealed that individuals with good trunk control were 4.6 times more likely to walk independently at 12 months and 2.9 times more likely to be independent in activities of daily living.Conclusion: The present study revealed that the trunk control test is useful for providing a prognosis of independence and walking at 1 year in individuals with SCI, independently of the neurologic level and the severity of the injury.
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Affiliation(s)
- Jimena Quinzaños-Fresnedo
- División de Rehabilitación Neurológica, Instituto Nacional de Rehabilitación, Ciudad de México, México,Correspondence to: Jimena Quinzaños-Fresnedo, División de Rehabilitación Neurologica, Instituto Nacional de RehabilitaciónAvenida México- Xochimilco No. 289, Col. Arenal de Guadalupe, Delegación Tlalpan, CP, Mexico City 14389, Mexico.
| | | | | | | | - Aída Barrera-Ortíz
- División de Rehabilitación Neurológica, Instituto Nacional de Rehabilitación, Ciudad de México, México
| | - Ramiro Pérez-Zavala
- División de Rehabilitación Neurológica, Instituto Nacional de Rehabilitación, Ciudad de México, México
| | - Antonio Rafael Villa-Romero
- División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
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Clinical efficacy of upper limb robotic therapy in people with tetraplegia: a pilot randomized controlled trial. Spinal Cord 2018; 57:49-57. [DOI: 10.1038/s41393-018-0190-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/10/2018] [Accepted: 07/23/2018] [Indexed: 11/08/2022]
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59
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Ahn JY, Song JE, Ann HW, Jeon Y, Ahn MY, Jung IY, Kim MH, Jeong W, Jeong SJ, Ku NS, Kim JM, Na S, Cho SR, Choi JY. Effects of Early Exercise Rehabilitation on Functional Recovery in Patients with Severe Sepsis. Yonsei Med J 2018; 59:843-851. [PMID: 30091317 PMCID: PMC6082977 DOI: 10.3349/ymj.2018.59.7.843] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/24/2018] [Accepted: 06/26/2018] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Severe sepsis is associated with functional disability among patients surviving an acute phase of infection. Efforts to improve functional impairment are important. We assessed the effects of early exercise rehabilitation on functional outcomes in patients with severe sepsis. MATERIALS AND METHODS A prospective, single-center, case-control study was conducted between January 2013 and May 2014 at a tertiary care center in Korea. Patients with severe sepsis and septic shock were enrolled and randomized to receive standard sepsis treatment or intervention. Intervention involved early targeted physical rehabilitation with sepsis treatment during hospitalization. Participants were assessed at enrollment, hospital discharge, and 6 months after enrollment. Functional recovery was measured using the Modified Barthel Index (MBI), Functional Independence Measure (FIM), and Instrumental Activities of Daily Living (IADL). RESULTS Forty participants (21 intervention patients) were included in an intention-to-treat analysis. There were no significant differences in baseline MBI, FIM, and IADL between groups. Intervention yielded greater improvement of MBI, FIM, and IADL in the intervention group at hospital discharge, but not significantly. Subgroup analysis of patients with APACHE II scores ≥10 showed significantly greater improvement of physical function at hospital discharge (MBI and FIM) in the intervention group, compared to the control group (55.13 vs. 31.75, p=0.048; 52.40 vs. 31.25, p=0.045). Intervention was significantly associated with improvement of MBI in multiple linear regression analysis (standardized coefficient 0.358, p=0.048). CONCLUSION Early physical rehabilitation may improve functional recovery at hospital discharge, especially in patients with high initial severity scores.
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Affiliation(s)
- Jin Young Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Je Eun Song
- Department of Internal Medicine, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
| | - Hea Won Ann
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yongduk Jeon
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Young Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - In Young Jung
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Moo Hyun Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Wooyoung Jeong
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Su Jin Jeong
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Su Ku
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - June Myung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sungwon Na
- Department of Anesthesiology, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Rae Cho
- Department of Rehabilitation Medicine and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Yong Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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Osterthun R, Tjalma TA, Spijkerman DCM, Faber WXM, van Asbeck FWA, Adriaansen JJE, Post MWM. Functional independence of persons with long-standing motor complete spinal cord injury in the Netherlands. J Spinal Cord Med 2018; 43:380-387. [PMID: 30124386 PMCID: PMC7241458 DOI: 10.1080/10790268.2018.1504427] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Context/Objective: Since life expectancy of persons with spinal cord injury (SCI) has improved, it is relevant to know whether this group is able to maintain functional abilities many years after onset of SCI. Objectives of this study were (1) to examine associations between time since injury (TSI) and functional independence in persons with long-standing SCI and (2) to explore associations between functional independence and level of injury, comorbidities, mental health, waist circumference and secondary health conditions (SHCs).Design: TSI-stratified cross-sectional study. Strata were 10-19, 20-29 and 30+ years.Setting: Community.Participants: 226 persons with long-standing SCI. Inclusion criteria: motor complete SCI; age at injury 18-35 years; TSI ≥ 10 years; current age 28-65 years; wheelchair dependency.Interventions: Not applicable.Outcome measures: The Spinal Cord Independence Measure III (SCIM) was administered by a trained research assistant. Level of injury, comorbidities, mental health, waist circumference and SHCs were assessed by a rehabilitation physician.Results: Mean TSI was 23.6 (SD 9.1) years. No significant differences in SCIM scores were found between TSI strata. SCIM scores were lower for persons with tetraplegia, autonomic dysreflexia, hypotension, more than four SHCs and a high waist circumference. In linear regression analyses, TSI nor age was associated with the SCIM total score. Only level of injury (β = -0.7; P < .001) and waist circumference (β = -0.1; P = .042) were independent determinants (explained variance 55%).Conclusion: We found no association between TSI and functional independence in persons with long-standing motor complete SCI. This study confirms the possible effect of overweight on functional independence.
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Affiliation(s)
- Rutger Osterthun
- Tolbrug Rehabilitation Centre, Jeroen Bosch Hospital, ‘s Hertogenbosch, the Netherlands,Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands,Rijndam Rehabilitation, Rotterdam, the Netherlands,Correspondence to: Rutger Osterthun, Rijndam Rehabilitation, Westersingel 300, 3015 LJ Rotterdam, the Netherlands.
| | - Tjitske A. Tjalma
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | | | | | - Floris W. A. van Asbeck
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Jacinthe J. E. Adriaansen
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Marcel W. M. Post
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands,Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
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Seif M, Curt A, Thompson AJ, Grabher P, Weiskopf N, Freund P. Quantitative MRI of rostral spinal cord and brain regions is predictive of functional recovery in acute spinal cord injury. Neuroimage Clin 2018; 20:556-563. [PMID: 30175042 PMCID: PMC6115607 DOI: 10.1016/j.nicl.2018.08.026] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 07/11/2018] [Accepted: 08/17/2018] [Indexed: 10/28/2022]
Abstract
Objective To reveal the immediate extent of trauma-induced neurodegenerative changes rostral to the level of lesion and determine the predictive clinical value of quantitative MRI (qMRI) following acute spinal cord injury (SCI). Methods Twenty-four acute SCI patients and 23 healthy controls underwent a high-resolution T1-weighted protocol. Eighteen of those patients and 20 of controls additionally underwent a multi-parameter mapping (MPM) MRI protocol sensitive to the content of tissue structure, including myelin and iron. Patients were examined clinically at baseline, 2, 6, 12, and 24 months post-SCI. We assessed volume and microstructural changes in the spinal cord and brain using T1-weighted MRI, magnetization transfer (MT), longitudinal relaxation rate (R1), and effective transverse relaxation rate (R2*) maps. Regression analysis determined associations between acute qMRI parameters and recovery. Results At baseline, cord area and its anterior-posterior width were decreased in patients, whereas MT, R1, and R2* parameters remained unchanged in the cord. Within the cerebellum, volume decrease was paralleled by increases of MT and R2* parameters. Early grey matter changes were observed within the primary motor cortex and limbic system. Importantly, early volume and microstructural changes of the cord and cerebellum predicted functional recovery following injury. Conclusions Neurodegenerative changes rostral to the level of lesion occur early in SCI, with varying temporal and spatial dynamics. Early qMRI markers of spinal cord and cerebellum are predictive of functional recovery. These neuroimaging biomarkers may supplement clinical assessments and provide insights into the potential of therapeutic interventions to enhance neural plasticity.
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Key Words
- APW, anterior posterior width
- Acute micro-structural changes
- Brain and spinal cord atrophy
- ISNCSCI, international standards for the neurological classification of spinal cord injury
- LRW, left right width
- MPM, multi-parameter mapping
- MT, magnetization transfer
- PD*, effective proton density
- Quantitative neuroimaging
- R1, longitudinal relaxation rate
- R2*, effective transverse relaxation rate
- ROI, region of interest
- SCA, spinal cord area
- SCI, spinal cord injury
- SCIM, spinal cord independence measure
- Spinal cord injury
- VBCT, voxel based cortical thickness
- VBM, voxel based morphometry
- VBQ, voxel based quantification
- Voxel-based morphometry and quantification
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Affiliation(s)
- Maryam Seif
- Spinal Cord Injury Center Balgrist, University of Zurich, Switzerland; Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Armin Curt
- Spinal Cord Injury Center Balgrist, University of Zurich, Switzerland
| | - Alan J Thompson
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK
| | - Patrick Grabher
- Spinal Cord Injury Center Balgrist, University of Zurich, Switzerland
| | - Nikolaus Weiskopf
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, London, UK
| | - Patrick Freund
- Spinal Cord Injury Center Balgrist, University of Zurich, Switzerland; Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK; Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, London, UK.
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Choukou MA, Best KL, Craven BC, Hitzig SL. Identifying and Classifying Quality of Life Tools for Assessing Neurogenic Bowel Dysfunction After Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2018; 25:1-22. [PMID: 30774286 DOI: 10.1310/sci18-00019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objectives: To identify and classify tools for assessing the influence of neurogenic bowel dysfunction (NBD) on quality of life (QoL) after spinal cord injury (SCI). Methods: In this systematic review, MEDLINE/PubMed, CINAHL, and PsycInfo were searched to identify studies assessing the influence of NBD on QoL (or related construct) after SCI. Two independent reviewers screened titles and abstracts, and both reviewers classified tools as subjective or objective according to Dijkers' theoretical QoL framework. Results: Seventy-two studies were identified, and 35 studies met the inclusion criteria. Five objective measures assessed the influence of NBD on QoL, which were validated for use in SCI, but no measure was condition-specific to NBD. Eight measures were classified as subjective tools; two had an established reliability and validity for SCI while six had some psychometric evidence for use in the SCI population. Five subjective measures (NBD score, Burwood QoL Questionnaire, Impediments to Community Integration [ICI] Scale, SCI-QoL Bowel Management Difficulties, and Survey of Neurogenic Bowel Characteristics) were developed specifically for SCI. The NBD score showed sensitivity to the influence of NBD on QoL in experimental trials. Conclusion: Thirteen tools assessed the influence of NBD on QoL in SCI. Although not developed specifically for SCI, the Health Utility Index (HUI-III) was the only tool identified that provided data on "QoL as utility" on the impact of NBD. The validated NBD score was the only condition-specific tool to assess QoL as "subjective well-being." Further validation of existing tools could help to inform practice and policy related to resource allocation for bowel care post SCI.
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Affiliation(s)
- Mohamed-Amine Choukou
- Département de réadaptation, Université Laval, Québec, Canada.,Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Institut de réadaptation en déficience physique de Québec, Québec City, Canada
| | - Krista L Best
- Département de réadaptation, Université Laval, Québec, Canada.,Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Institut de réadaptation en déficience physique de Québec, Québec City, Canada
| | - B Catharine Craven
- Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Division of Physiatry, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sander L Hitzig
- Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,School of Kinesiology and Health Science, Faculty ofHealth, York University, Toronto, Ontario, Canada
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Bolliger M, Blight AR, Field-Fote EC, Musselman K, Rossignol S, Barthélemy D, Bouyer L, Popovic MR, Schwab JM, Boninger ML, Tansey KE, Scivoletto G, Kleitman N, Jones LAT, Gagnon DH, Nadeau S, Haupt D, Awai L, Easthope CS, Zörner B, Rupp R, Lammertse D, Curt A, Steeves J. Lower extremity outcome measures: considerations for clinical trials in spinal cord injury. Spinal Cord 2018; 56:628-642. [PMID: 29700477 PMCID: PMC6131138 DOI: 10.1038/s41393-018-0097-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/28/2018] [Accepted: 03/06/2018] [Indexed: 11/29/2022]
Abstract
STUDY DESIGN This is a focused review article. OBJECTIVES To identify important concepts in lower extremity (LE) assessment with a focus on locomotor outcomes and provide guidance on how existing outcome measurement tools may be best used to assess experimental therapies in spinal cord injury (SCI). The emphasis lies on LE outcomes in individuals with complete and incomplete SCI in Phase II-III trials. METHODS This review includes a summary of topics discussed during a workshop focusing on LE function in SCI, conceptual discussion of corresponding outcome measures and additional focused literature review. RESULTS There are a number of sensitive, accurate, and responsive outcome tools measuring both quantitative and qualitative aspects of LE function. However, in trials with individuals with very acute injuries, a baseline assessment of the primary (or secondary) LE outcome measure is often not feasible. CONCLUSION There is no single outcome measure to assess all individuals with SCI that can be used to monitor changes in LE function regardless of severity and level of injury. Surrogate markers have to be used to assess LE function in individuals with severe SCI. However, it is generally agreed that a direct measurement of the performance for an appropriate functional activity supersedes any surrogate marker. LE assessments have to be refined so they can be used across all time points after SCI, regardless of the level or severity of spinal injury. SPONSORS Craig H. Neilsen Foundation, Spinal Cord Outcomes Partnership Endeavor.
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Affiliation(s)
- Marc Bolliger
- Spinal Cord Injury Center, University Hospital Balgrist, University Zurich, Zurich, Switzerland.
- Swiss Center for Clinical Movement Analysis (SCMA), Zurich, Switzerland.
| | | | - Edelle C Field-Fote
- Shepherd Center, Georgia Institute of Technology, School of Biological Sciences, Emory University School of Medicine, Division of Physical Therapy, Atlanta, GA, USA
| | - Kristin Musselman
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Serge Rossignol
- Department of Neuroscience, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Dorothy Barthélemy
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, and Centre de recherche interdisciplinaire en réadaptation (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM) du CIUSSS du Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada
| | - Laurent Bouyer
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, Canada
| | - Milos R Popovic
- Rehabilitation Engineering Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Jan M Schwab
- Department of Neurology, Spinal Cord Injury Division and Departments of Neuroscience and Physical Medicine and Rehabilitation, The Neurological Institute, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Michael L Boninger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh & Department of Veterans Affairs, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Keith E Tansey
- Methodist Rehabilitation Center, University of Mississippi Medical Center and Jackson VA Medical Center, Jackson, MS, USA
| | - Giorgio Scivoletto
- Spinal Cord Unit and Spinal Rehabilitation (SpiRe) laboratory, IRCCS Fondazione S. Lucia, Rome, Italy
| | | | | | - Dany H Gagnon
- School of Rehabilitation, Université de Montréal and Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation, Institut universitaire sur la réadaptation en déficience physique de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Sylvie Nadeau
- School of Rehabilitation, Université de Montréal and Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation, Institut universitaire sur la réadaptation en déficience physique de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Dirk Haupt
- University of British Columbia, Vancouver, BC, Canada
| | - Lea Awai
- Spinal Cord Injury Center, University Hospital Balgrist, University Zurich, Zurich, Switzerland
| | - Chris S Easthope
- Spinal Cord Injury Center, University Hospital Balgrist, University Zurich, Zurich, Switzerland
| | - Björn Zörner
- Spinal Cord Injury Center, University Hospital Balgrist, University Zurich, Zurich, Switzerland
| | - Ruediger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Dan Lammertse
- Craig Hospital, Englewood, Colorado, University of Colorado School of Medicine, Colorado, USA
| | - Armin Curt
- Spinal Cord Injury Center, University Hospital Balgrist, University Zurich, Zurich, Switzerland
- Swiss Center for Clinical Movement Analysis (SCMA), Zurich, Switzerland
| | - John Steeves
- University of British Columbia, Vancouver, BC, Canada
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Rapidi CA, Tederko P, Moslavac S, Popa D, Branco CA, Kiekens C, Varela Donoso E, Christodoulou N. Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice for persons with spinal cord injury. The European PRM position (UEMS PRM Section). Eur J Phys Rehabil Med 2018; 54:797-807. [PMID: 29952157 DOI: 10.23736/s1973-9087.18.05374-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Spinal cord injury (SCI) is a devastating condition and a challenge for every health system and every society. This EBPP represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians for people with SCI. The aim of the paper was to improve Physical and Rehabilitation Medicine (PRM) physicians' professional practice for persons with SCI in order to improve their functionality, social and community reintegration, and to overcome activity limitations and/or participation restrictions. EVIDENCE ACQUISITION A systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. EVIDENCE SYNTHESIS The systematic literature review is reported together with thirty-eight recommendations resulting from the Delphi procedure. CONCLUSIONS The professional role of PRM physicians who have expertise in the rehabilitation of SCI is to run rehabilitation programmes in multi-professional teams, working in an interdisciplinary way in a variety of settings to improve the functioning of people with SCI.
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Affiliation(s)
| | - Piotr Tederko
- Department of Rehabilitation, Medical University of Warsaw, Warsaw, Poland
| | - Sasa Moslavac
- Department of Physical and Rehabilitation Medicine, Special Hospital for Medical Rehabilitation, Varaždinske Toplice, Croatia
| | - Daiana Popa
- Clinical Rehabilitation Hospital Felix-Spa Bihor County, Oradea, Romania
| | - Catarina A Branco
- Department of Physical and Rehabilitation Medicine, Centro Hospitalar de Entre o Douro e Vouga E.P.E, Porto, Portugal
| | - Carlotte Kiekens
- Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Enrique Varela Donoso
- Physical and Rehabilitation Medicine Department, Complutense University School of Medicine, Madrid, Spain
| | - Nicolas Christodoulou
- Medical School, European University Cyprus, Nicosia, Cyprus.,UEMS PRM Section, Brussels, Belgium
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65
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Saberi H, Vosoughi F, Derakhshanrad N, Yekaninejad M, Khan ZH, Kohan AH, Parvaneh S, Ghahari S, Agheli F, Vosoughi F. Development of Persian version of the Spinal Cord Independence Measure III assessed by interview: a psychometric study. Spinal Cord 2018; 56:980-986. [DOI: 10.1038/s41393-018-0160-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/27/2018] [Accepted: 04/28/2018] [Indexed: 11/09/2022]
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66
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Zhu H, Poon W, Liu Y, Leung GKK, Wong Y, Feng Y, Ng SCP, Tsang KS, Sun DTF, Yeung DK, Shen C, Niu F, Xu Z, Tan P, Tang S, Gao H, Cha Y, So KF, Fleischaker R, Sun D, Chen J, Lai J, Cheng W, Young W. Phase I-II Clinical Trial Assessing Safety and Efficacy of Umbilical Cord Blood Mononuclear Cell Transplant Therapy of Chronic Complete Spinal Cord Injury. Cell Transplant 2018; 25:1925-1943. [PMID: 27075659 DOI: 10.3727/096368916x691411] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Umbilical cord blood-derived mononuclear cell (UCB-MNC) transplants improve recovery in animal spinal cord injury (SCI) models. We transplanted UCB-MNCs into 28 patients with chronic complete SCI in Hong Kong (HK) and Kunming (KM). Stemcyte Inc. donated UCB-MNCs isolated from human leukocyte antigen (HLA ≥4:6)-matched UCB units. In HK, four patients received four 4-μl injections (1.6 million cells) into dorsal entry zones above and below the injury site, and another four received 8-μl injections (3.2 million cells). The eight patients were an average of 13 years after C5-T10 SCI. Magnetic resonance diffusion tensor imaging of five patients showed white matter gaps at the injury site before treatment. Two patients had fiber bundles growing across the injury site by 12 months, and the rest had narrower white matter gaps. Motor, walking index of SCI (WISCI), and spinal cord independence measure (SCIM) scores did not change. In KM, five groups of four patients received four 4-μl (1.6 million cells), 8-μl (3.2 million cells), 16-μl injections (6.4 million cells), 6.4 million cells plus 30 mg/kg methylprednisolone (MP), or 6.4 million cells plus MP and a 6-week course of oral lithium carbonate (750 mg/day). KM patients averaged 7 years after C3-T11 SCI and received 3-6 months of intensive locomotor training. Before surgery, only two patients walked 10 m with assistance and did not need assistance for bladder or bowel management before surgery. The rest could not walk or do their bladder and bowel management without assistance. At about a year (41-87 weeks), WISCI and SCIM scores improved: 15/20 patients walked 10 m ( p = 0.001) and 12/20 did not need assistance for bladder management ( p = 0.001) or bowel management ( p = 0.002). Five patients converted from complete to incomplete (two sensory, three motor; p = 0.038) SCI. We conclude that UCB-MNC transplants and locomotor training improved WISCI and SCIM scores. We propose further clinical trials.
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Affiliation(s)
- Hui Zhu
- Kunming General Hospital of Chengdu Military Command, Yunnan, P.R. China.,Kunming Tongren Hospital, Yunnan, P.R. China
| | - Waisang Poon
- Prince of Wales Hospital, Division of Neurosurgery, Department of Surgery, Chinese University of Hong Kong, Shatin, Hong Kong, SAR, P.R. China
| | - Yansheng Liu
- Kunming General Hospital of Chengdu Military Command, Yunnan, P.R. China.,Kunming Tongren Hospital, Yunnan, P.R. China
| | | | - Yatwa Wong
- Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR, P.R. China
| | - Yaping Feng
- Kunming General Hospital of Chengdu Military Command, Yunnan, P.R. China
| | - Stephanie C P Ng
- Prince of Wales Hospital, Division of Neurosurgery, Department of Surgery, Chinese University of Hong Kong, Shatin, Hong Kong, SAR, P.R. China
| | - Kam Sze Tsang
- Prince of Wales Hospital, Division of Neurosurgery, Department of Surgery, Chinese University of Hong Kong, Shatin, Hong Kong, SAR, P.R. China
| | - David T F Sun
- Prince of Wales Hospital, Division of Neurosurgery, Department of Surgery, Chinese University of Hong Kong, Shatin, Hong Kong, SAR, P.R. China
| | - David K Yeung
- Prince of Wales Hospital, Division of Neurosurgery, Department of Surgery, Chinese University of Hong Kong, Shatin, Hong Kong, SAR, P.R. China
| | - Caihong Shen
- Kunming General Hospital of Chengdu Military Command, Yunnan, P.R. China.,Kunming Tongren Hospital, Yunnan, P.R. China
| | - Fang Niu
- Kunming General Hospital of Chengdu Military Command, Yunnan, P.R. China.,Kunming Tongren Hospital, Yunnan, P.R. China
| | - Zhexi Xu
- Kunming General Hospital of Chengdu Military Command, Yunnan, P.R. China.,Kunming Tongren Hospital, Yunnan, P.R. China
| | - Pengju Tan
- Kunming General Hospital of Chengdu Military Command, Yunnan, P.R. China.,Kunming Tongren Hospital, Yunnan, P.R. China
| | - Shaofeng Tang
- Kunming General Hospital of Chengdu Military Command, Yunnan, P.R. China
| | - Hongkun Gao
- Kunming General Hospital of Chengdu Military Command, Yunnan, P.R. China.,Kunming Tongren Hospital, Yunnan, P.R. China
| | - Yun Cha
- Kunming General Hospital of Chengdu Military Command, Yunnan, P.R. China
| | - Kwok-Fai So
- Department of Ophthalmology and State Key Laboratory of Brain and Cognitive Science, The University of Hong Kong, SAR, P.R. China.,GHM Institute of CNS Regeneration, and Medical Key Laboratory of Brain Function and Diseases, Jinan University, Guangzhou, P.R. China.,China Spinal Cord Injury Network, Hong Kong Science Technology Park, Hong Kong, SAR, P.R. China
| | | | - Dongming Sun
- W. M. Keck Center for Collaborative Neuroscience, Rutgers University, Piscataway, NJ, USA
| | - John Chen
- China Spinal Cord Injury Network, Hong Kong Science Technology Park, Hong Kong, SAR, P.R. China
| | - Jan Lai
- China Spinal Cord Injury Network, Hong Kong Science Technology Park, Hong Kong, SAR, P.R. China
| | - Wendy Cheng
- China Spinal Cord Injury Network, Hong Kong Science Technology Park, Hong Kong, SAR, P.R. China
| | - Wise Young
- China Spinal Cord Injury Network, Hong Kong Science Technology Park, Hong Kong, SAR, P.R. China.,W. M. Keck Center for Collaborative Neuroscience, Rutgers University, Piscataway, NJ, USA
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Versace V, Langthaler PB, Höller Y, Frey VN, Brigo F, Sebastianelli L, Saltuari L, Nardone R. Abnormal cortical neuroplasticity induced by paired associative stimulation after traumatic spinal cord injury: A preliminary study. Neurosci Lett 2018; 664:167-171. [PMID: 29138092 DOI: 10.1016/j.neulet.2017.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/08/2017] [Accepted: 11/03/2017] [Indexed: 11/28/2022]
Abstract
We aimed at assessing in this pilot study whether patients with spinal cord injury (SCI) show alterations of sensorimotor plasticity within the primary motor cortex (M1). Since learning in human M1 occurs through LTP-like mechanisms, we employed the paired associative stimulation (PAS) protocol by transcranial magnetic stimulation (TMS), which is able to induce LTP-like effects in M1, in subjects with chronic SCI. We found that PAS protocol significantly increased corticospinal excitability as long as 30min in healthy subjects and in SCI patients with good motor recovery, while it was followed by a non-significant increase of MEP amplitude in the SCI patients with poor functional recovery. These findings suggest that the level of LTP-like phenomena is correlated with long term recovery and support the correlation between the ability of inducing excitability changes using TMS and the process of motor recovery. Increased cortical plasticity might imply greater capability for neuromodulation.
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Affiliation(s)
- Viviana Versace
- Department of Neurorehabilitation, Hospital of Sterzing, Sterzing, Italy; Research Unit for Neurorehabilitation of South Tyrol, Bozen, Italy
| | - Patrick B Langthaler
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Department of Mathematics, Paris Lodron University of Salzburg, Austria; Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University, Salzburg, Austria
| | - Yvonne Höller
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University, Salzburg, Austria
| | - Vanessa N Frey
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University, Salzburg, Austria; Department of Neurological and Movement Sciences, Section of Clinical Neurology, University of Verona, Verona, Italy
| | - Francesco Brigo
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy; Department of Neurological and Movement Sciences, Section of Clinical Neurology, University of Verona, Verona, Italy
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Hospital of Sterzing, Sterzing, Italy; Research Unit for Neurorehabilitation of South Tyrol, Bozen, Italy
| | - Leopold Saltuari
- Department of Neurorehabilitation, Hospital of Sterzing, Sterzing, Italy; Research Unit for Neurorehabilitation of South Tyrol, Bozen, Italy; Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Raffaele Nardone
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University, Salzburg, Austria; Department of Neurology, Franz Tappeiner Hospital, Merano, Italy.
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68
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Shabany M, Nasrabadi AN, Rahimi-Movaghar V, Mansournia MA, Mohammadi N, Pruitt SD. Reliability and validity of the Persian version of the spinal cord injury lifestyle scale and the health behavior questionnaire in persons with spinal cord injury. Spinal Cord 2018; 56:509-515. [PMID: 29335476 DOI: 10.1038/s41393-017-0056-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/29/2017] [Accepted: 12/16/2017] [Indexed: 01/02/2023]
Abstract
STUDY DESIGN Cross-sectional psychometric study. OBJECTIVE To evaluate the reliability and validity of a spinal cord injury lifestyle scale (SCILS) and Health Behavior Questionnaire (HBQ) in the Persian language for persons with spinal cord injury (SCI). SETTING Participants were selected among those referred to health centers and the Brain and Spinal Cord Injury Research Center. METHOD In accordance with standard procedure for translation, two questionnaires, the SCILS and HBQ, were translated using a forward and backward translation approach by professional translators. Face validity of the questionnaires was assessed by ten persons with SCI and content validity was agreed upon by 12 professors from health care teaching universities. To test the final versions of both questionnaires, 97 persons with SCI were included using a consecutive sampling method. Other questionnaires were used to assess concurrent validity (secondary impairment checklist, as well as SCILS and HBQ) and convergent validity (impact of event scale revised, brief symptom inventory, beck depression inventory, and functional independence measure). RESULTS Internal consistency of SCILS and HBQ, assessed by Cronbach's alpha, was 0.75 for SCILS and 0.85 for HBQ. Test-retest reliability intraclass correlations were 0.86 and 0.92 for SCILS and HBQ, respectively. The number of current secondary impairments had a significant and negative correlation with SCILS (r = -0.22, P < 0.001), but it was not correlated with HBQ. SCILS had a significant and strong correlation with HBQ (r = 0.65, P < 0.001). CONCLUSION SCILS and HBQ can be used for measuring the health behavior of persons with SCI in Iran.
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Affiliation(s)
- Maryam Shabany
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Nikbakht Nasrabadi
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.,Dept. of Medical Surgical Nursing & Deputy Dean for International Affairs, Nursing and Midwifery School, Tehran University of Medical Sciences, Tehran, Iran
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Nooredin Mohammadi
- Dept. of Critical Care Nursing, Nursing and Midwifery School, Iran University of Medical Sciences, Tehran, Iran
| | - Sheri D Pruitt
- Behavioral Science Integration Kaiser Permanente, The Permanente Medical Group, North Valley, Sacramento, CA, USA
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Singh H, Unger J, Zariffa J, Pakosh M, Jaglal S, Craven BC, Musselman KE. Robot-assisted upper extremity rehabilitation for cervical spinal cord injuries: a systematic scoping review. Disabil Rehabil Assist Technol 2018; 13:704-715. [PMID: 29334467 DOI: 10.1080/17483107.2018.1425747] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Abstact Purpose: To provide an overview of the feasibility and outcomes of robotic-assisted upper extremity training for individuals with cervical spinal cord injury (SCI), and to identify gaps in current research and articulate future research directions. MATERIALS AND METHODS A systematic search was conducted using Medline, Embase, PsycINFO, CCTR, CDSR, CINAHL and PubMed on June 7, 2017. Search terms included 3 themes: (1) robotics; (2) SCI; (3) upper extremity. Studies using robots for upper extremity rehabilitation among individuals with cervical SCI were included. Identified articles were independently reviewed by two researchers and compared to pre-specified criteria. Disagreements regarding article inclusion were resolved through discussion. The modified Downs and Black checklist was used to assess article quality. Participant characteristics, study and intervention details, training outcomes, robot features, study limitations and recommendations for future studies were abstracted from included articles. RESULTS Twelve articles (one randomized clinical trial, six case series, five case studies) met the inclusion criteria. Five robots were exoskeletons and three were end-effectors. Sample sizes ranged from 1 to 17 subjects. Articles had variable quality, with quality scores ranging from 8 to 20. Studies had a low internal validity primarily from lack of blinding or a control group. Individuals with mild-moderate impairments showed the greatest improvements on body structure/function and performance-level measures. This review is limited by the small number of articles, low-sample sizes and the diversity of devices and their associated training protocols, and outcome measures. CONCLUSIONS Preliminary evidence suggests robot-assisted interventions are safe, feasible and can reduce active assistance provided by therapists. Implications for rehabilitation Robot-assisted upper extremity training for individuals with cervical spinal cord injury is safe, feasible and can reduce hands-on assistance provided by therapists. Future research in robotics rehabilitation with individuals with spinal cord injury is needed to determine the optimal device and training protocol as well as effectiveness.
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Affiliation(s)
- Hardeep Singh
- a Toronto Rehabilitation Institute-University Health Network , Toronto , ON , Canada.,b Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada
| | - Janelle Unger
- a Toronto Rehabilitation Institute-University Health Network , Toronto , ON , Canada.,b Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada
| | - José Zariffa
- a Toronto Rehabilitation Institute-University Health Network , Toronto , ON , Canada.,b Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada.,c Institute of Biomaterials and Biomedical Engineering , University of Toronto , Toronto , ON , Canada
| | - Maureen Pakosh
- a Toronto Rehabilitation Institute-University Health Network , Toronto , ON , Canada
| | - Susan Jaglal
- a Toronto Rehabilitation Institute-University Health Network , Toronto , ON , Canada.,b Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada.,d Department of Physical Therapy , University of Toronto , Toronto , ON , Canada.,e Department of Health Policy, Management and Evaluation , University of Toronto , Toronto , ON , Canada
| | - B Catharine Craven
- a Toronto Rehabilitation Institute-University Health Network , Toronto , ON , Canada.,b Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada.,f Division of Physical Medicine and Rehabilitation, Faculty of Medicine , University of Toronto , Toronto , ON , Canada
| | - Kristin E Musselman
- a Toronto Rehabilitation Institute-University Health Network , Toronto , ON , Canada.,b Rehabilitation Sciences Institute , University of Toronto , Toronto , ON , Canada.,d Department of Physical Therapy , University of Toronto , Toronto , ON , Canada
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Wouda EMN, Stienstra Y, van der Werf TS, Kerstjens H, de Lange WCM, Coppes M, Kuijlen J, Tepper M, Akkerman OW. Neurological and functional recovery in tuberculosis patients with spinal cord injury in The Netherlands. NeuroRehabilitation 2017; 40:439-445. [PMID: 28222564 DOI: 10.3233/nre-161431] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Spinal tuberculosis (TB) accounts for approximately 1% to 3% of all TB cases and it can cause a wide range of neurological symptoms, from none to a complete spinal cord injury (SCI), resulting in complete paraplegia or tetraplegia. OBJECTIVES To describe the functional and neurological outcome of SCI caused by TB. METHODS Retrospective data on the admission period was combined with prospectively collected data on long-term follow-up. Primary outcome was neurological outcome in terms of motor function. Secondary outcome measures were functional outcome in terms of level of independence and community participation. Results were compared to the outcome in patients with SCI due to trauma. RESULTS Six TB patients with complete motor SCI (American Spinal Injury Association Impairment Scale (AIS) A or B) were compared to eighteen patients with traumatic SCI. Most TB patients regained almost full neurological function (median motor score improved from 50 to 100), and reached high levels of independence, whereas trauma patients did not improve neurologically (median motor score remained 50) and reached a plateau in level of independence. CONCLUSIONS SCI due to tuberculosis in the Netherlands shows remarkable improvement in both neurological and functional outcome, especially compared with traumatic SCI.
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Affiliation(s)
- Eva M N Wouda
- Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ymkje Stienstra
- Department of Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tjip S van der Werf
- Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Huib Kerstjens
- Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wiel C M de Lange
- Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Tuberculosis Center Beatrixoord, Haren, The Netherlands
| | - Maarten Coppes
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Spine Center Groningen, Groningen, The Netherlands
| | - Jos Kuijlen
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Spine Center Groningen, Groningen, The Netherlands
| | - Marga Tepper
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Onno W Akkerman
- Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Tuberculosis Center Beatrixoord, Haren, The Netherlands
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Administration of assessment instruments during the first rehabilitation of patients with spinal cord injury: a retrospective chart analysis. Spinal Cord 2017; 56:322-331. [PMID: 29259347 DOI: 10.1038/s41393-017-0039-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/26/2017] [Accepted: 11/12/2017] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Retrospective chart analysis. OBJECTIVES To examine which professionals administered which assessment instruments in which patient in clinical practice during first rehabilitation after newly acquired spinal cord injury (SCI) and the differences in the frequencies of different assessments between patient groups. SETTING Specialized SCI acute care and rehabilitation clinic. METHODS Patients after SCI, aged 18 years and above, admitted for first rehabilitation between December 2014 and December 2015 were analyzed. Descriptive statistics of 54 selected assessments. p values based on the χ 2 test were calculated for assessments used in both paraplegic and tetraplegic patients. RESULTS One hundred and nineteen patients were screened. Forty-one assessments were administered, of which 10 on average more than once per patient. The most frequently used assessments were Spinal Cord Independence Measure III (7.7 times per patient), Skin Assessment (3.6 times), and Manual Muscle Test (3.2 times for Lower Extremities; 2.5 times for Upper Extremities). The American Spinal Injury Association Impairment Scale was administered on average 1.9 times per patient. More variation in the number of assessments per patient was observed in patients with complete and incomplete lesions compared to patients with paraplegia and tetraplegia. CONCLUSION Assessments covering neurological functioning, mobility, and self-care are used in clinical practice during first rehabilitation of patients with SCI, while others covering autonomic functioning, pain, participation, or quality of life are still missing. Based on these observations and national and international requirements, a meaningful standard for an assessment toolkit, applicable in general and in specific subgroups, needs to be defined and implemented.
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Xian H, Xu LW, Li CH, Hao JM, Wan WX, Feng GD, Lian KJ, Li L. Spontaneous spinal epidural hematomas: One case report and rehabilitation outcome. Medicine (Baltimore) 2017; 96:e8473. [PMID: 29095302 PMCID: PMC5682821 DOI: 10.1097/md.0000000000008473] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
RATIONALE Spontaneous spinal epidural hematoma (SSEH) is a relatively rare but potentially disabling disease, and the classical presentation of it includes an acute onset of severe, sometimes radiating back or neck pain, followed by signs and symptoms of rapidly evolving nerve root or spinal cord compression. PATIENT CONCERNS Here, we report a 26-year-old female patient presented with weakness in bilateral lower extremities, progressing to intense paraplegia and anesthesia without recent medical history of trauma, infection, surgery, or drug use. DIAGNOSIS A magnetic resonance imaging (MRI) scan of spinal cord was planned and a posterior epidural hematoma of the thoracic spine was observed. INTERVENTIONS A posterior decompression and hematoma evacuation was performed after diagnosis immediately. Early rehabilitation program of the specific kind spinal cord injury was formulated and implemented. OUTCOMES The patient finally can handle basic living activities, such as completing wheelchair locomotion, transferring from bed to wheelchair independently after 3 months of rehabilitation. LESSONS SSEH is a rarely occurring case in emergency. Acute chest pain and paraplegia could be the initial presentation of acute spinal epidural hemorrhage, but the diagnosis of patient without classical manifestations is still a challenge for doctors. Early diagnosis, prompt decompression, and individualized rehabilitation program can improve the prognosis and outcome.
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Affiliation(s)
- Hang Xian
- Orthopedics Department, The 175th Hospital of PLA (Affiliated Southeast Hospital of Xiamen University), Zhangzhou, Fujian Province
| | - Li-Wei Xu
- Hand and Foot Surgery Department, The 11th Hospital of PLA, Yining, Xinjiang Province
| | - Cong-Han Li
- Rehabilitation Medicine Department, The 175th Hospital of PLA (Affiliated Southeast Hospital of Xiamen University), Zhangzhou, Fujian Province, P.R. China
| | - Jian-Ming Hao
- Rehabilitation Medicine Department, The 175th Hospital of PLA (Affiliated Southeast Hospital of Xiamen University), Zhangzhou, Fujian Province, P.R. China
| | - Wei-Xia Wan
- Rehabilitation Medicine Department, The 175th Hospital of PLA (Affiliated Southeast Hospital of Xiamen University), Zhangzhou, Fujian Province, P.R. China
| | - Guo-Dong Feng
- Rehabilitation Medicine Department, The 175th Hospital of PLA (Affiliated Southeast Hospital of Xiamen University), Zhangzhou, Fujian Province, P.R. China
| | - Ke-Jian Lian
- Orthopedics Department, The 175th Hospital of PLA (Affiliated Southeast Hospital of Xiamen University), Zhangzhou, Fujian Province
| | - Lin Li
- Rehabilitation Medicine Department, The 175th Hospital of PLA (Affiliated Southeast Hospital of Xiamen University), Zhangzhou, Fujian Province, P.R. China
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Catharine Craven B, Kurban D, Farahani F, Rivers CS, Ho C, Linassi AG, Gagnon DH, O'Connell C, Ethans K, Bouyer LJ, Noonan VK. Predicting rehabilitation length of stay in Canada: It's not just about impairment. J Spinal Cord Med 2017; 40:676-686. [PMID: 28899285 PMCID: PMC5778931 DOI: 10.1080/10790268.2017.1368962] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Current tertiary Spinal Cord Injury (SCI) rehabilitation funding and rehabilitation length of stay (R-LOS) in most North American jurisdictions are linked to an individual's impairment. Our objectives were to: 1) describe the impact of relevant demographic, impairment and medical complexity variables at rehabilitation admission on R-LOS among adult Canadians with traumatic SCI; and 2) identify factors which extend R-LOS. METHODS Data from 1,376 adults with traumatic SCI were obtained via chart abstraction and administrative data linkage from 15 Rick Hansen SCI Registry sites (2004-2014). Variables included age, sex, neurological impairment (level, severity), rehabilitation onset days, R-LOS, Glasgow Coma Score (GCS) at admission, prior ventilation or endotracheal tube (Vent/ETT), or indwelling bladder catheter at acute discharge, pain interference score, intensive care unit (ICU) length of stay (LOS), and lower extremity motor scores (LEMS) at rehabilitation admission. Variables related to R-LOS in bivariate analysis were included in multivariate analysis to determine their impact on R-LOS. RESULTS Prior Vent/ETT tube, indwelling bladder catheter, GCS, LEMS, and neurological impairment were related to R-LOS in bivariate analysis. Multivariate linear regression analyses identified five variables as significant predictors: age, Vent/ETT for >24 hours in acute care, indwelling bladder catheter at acute discharge, LEMS, and NLI/AIS subgroup at rehabilitation admission explained 32% of the variation in R-LOS (p<0.001). CONCLUSIONS Based on the enclosed formula, and knowledge of an individual's age at injury, spinal cord impairment (level and severity), prior Vent/ETT, presence of an indwelling bladder catheter, and LEMS at admission, administrators and clinicians may readily identify patients for whom an extended R-LOS beyond conventional LOS targets is likely.
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Affiliation(s)
- B. Catharine Craven
- Brain and Spinal Cord Rehabilitation Program, Toronto, ON, Canada,Neural Engineering & Therapeutics Team, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada,Dept. of Medicine, Division of PM&R, University of Toronto, Toronto, ON, Canada,University Health Network Toronto Rehab Lyndhurst Centre, Toronto, ON, Canada
| | | | - Farnoosh Farahani
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Carly S. Rivers
- Rick Hansen Institute, Vancouver, BC, Canada,Correspondence to: Carly S. Rivers, Rick Hansen Institute, 6400 Blusson Spinal Cord Centre, Vancouver, BC, Canada.
| | - Chester Ho
- Allied Health, AHS Calgary Zone, Calgary, AB, Canada,Division of Physical Medicine & Rehabilitation, Dept of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - A. Gary Linassi
- Department of Physical Medicine and Rehabilitation, University of Saskatchewan, Saskatoon, SK, Canada,Spinal Cord Injury and Amputation Programs, Saskatoon Health Region, Saskatoon, SK, Canada
| | - Dany H. Gagnon
- École de réadaptation, Faculté de médecine, Université de Montréal, Montréal, QC, Canada
| | - Colleen O'Connell
- Physical Medicine & Rehabilitation, Dalhousie University, Faculty of Medicine, Fredericton, NB, Canada
| | - Karen Ethans
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Laurent J. Bouyer
- Department of Rehabilitation, Université Laval & Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Québec City, QC, Canada
| | - Vanessa K. Noonan
- Rick Hansen Institute, Vancouver, BC, Canada,University of British Columbia, Vancouver, BC, Canada
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Bazant ES, Himelfarb Hurwitz EJ, Onguti BN, Williams EK, Noon JH, Xavier CA, Garcia FDS, Gichangi A, Gabbow M, Musakhi P, Lee Kirby R. Wheelchair services and use outcomes: A cross-sectional survey in Kenya and the Philippines. Afr J Disabil 2017; 6:318. [PMID: 29134178 PMCID: PMC5675920 DOI: 10.4102/ajod.v6i0.318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 04/03/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The World Health Organisation recommends that services accompany wheelchair distribution. This study examined the relationship of wheelchair service provision in Kenya and the Philippines and wheelchair-use-related outcomes. METHOD We surveyed 852 adult basic manual wheelchair users. Participants who had received services and those who had not were sought in equal numbers from wheelchair-distribution entities. Outcomes assessed were daily wheelchair use, falls, unassisted outdoor use and performance of activities of daily living (ADL). Descriptive, bivariate and multivariable regression model results are presented. RESULTS Conditions that led to the need for a basic wheelchair were mainly spinal cord injury, polio/post-polio, and congenital conditions. Most Kenyans reported high daily wheelchair use (60%) and ADL performance (80%), while these practices were less frequent in the Philippine sample (42% and 74%, respectively). Having the wheelchair fit assessed while the user propelled the wheelchair was associated with greater odds of high ADL performance in Kenya (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.6, 5.1) and the Philippines (OR 2.8, 95% CI 1.8, 4.5). Wheelchair-related training was associated with high ADL performance in Kenya (OR 3.2, 95% CI 1.3, 8.4). In the Philippines, training was associated with greater odds of high versus no daily wheelchair use but also odds of serious versus no falls (OR 2.5, 95% CI 1.4, 4.5). CONCLUSION Select services that were associated with some better wheelchair use outcomes and should be emphasised in service delivery. Service providers should be aware that increased mobility may lead to serious falls.
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Affiliation(s)
| | | | | | | | | | | | - Ferdiliza D S Garcia
- College of Allied Medical Professions, University of the Philippines, Manila, Philippines
| | | | - Mohammed Gabbow
- National Council for Persons With Disabilities, Government of Kenya, Kenya
| | - Peter Musakhi
- Ministry of East African Community (EAC), Labour and Social Protection, Government of Kenya, Kenya
| | - R Lee Kirby
- Division of Physical Medicine & Rehabilitation, Dalhousie University, Canada
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SCIM III (Spinal Cord Independence Measure version III): reliability of assessment by interview and comparison with assessment by observation. Spinal Cord 2017; 56:46-51. [PMID: 28895576 DOI: 10.1038/sc.2017.97] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/15/2017] [Accepted: 07/19/2017] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Psychometric study. OBJECTIVES The objective of this study was to examine the reliability of the Spinal Cord Independence Measure III (SCIM III) by interview and compare the findings with those of assessment by observation. SETTING This study was conducted at Loewenstein Rehabilitation Hospital, Israel. METHODS Thirty-five spinal cord lesion (SCL) patients who underwent rehabilitation at Loewenstein Rehabilitation Hospital in Israel were assessed during the last week before discharge with SCIM III by observation and by interview. Nineteen of the patients were also assessed by interview by a third rater to examine inter-rater reliability. Total agreement, kappa, Bland-Altman plots and intraclass correlation (ICC) were used for comparison between interviewers and between interviews and observations. RESULTS Total agreement between the interviewers' scores and between interviews and observations was low to moderate (kappa coefficient 0.11-0.80). Bland-Altman analysis revealed good agreement, with low mean difference for almost all SCIM III subscales and total scores, between pairs of interviewers (bias -4.15, limits of agreement -22.51 to 14.19, for total score) and between interviews and observations (bias 1.62, limits of agreement -20.55 to 23.81, for total score). ICC coefficients for the SCIM III subscales and total scores were high (0.637-0.916). CONCLUSION The findings of this study support the reliability and validity of SCIM III by interview, which appears to be useful for research of SCL patient groups. Individual scoring of SCIM III by interview, however, varied prominently between raters. Therefore, SCIM III by interview should be used with caution for clinical purposes, probably by raters whose scoring deviation, in relation to observation scores, is known.
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Abstract
This article focuses on patient-reported and clinician-reported outcome measures in spine trauma care. The measurement of the quality of care and functional and health-related quality of life outcomes of spine trauma patients has become increasingly important. However, no outcome instrument is specifically designed, validated, or universally adapted for this specific patient population. Issues specific to spinal trauma patients may not be adequately addressed by the instruments that are currently used in the literature and the daily clinical practice. The AOSpine Knowledge Forum Trauma initiated a project to develop and validate such instruments for spine trauma patients. To reflect the different perspectives of patients and the treating surgeons, 2 separate tools are being developed: the Patient Reported Outcome Spine Trauma (AOSpine PROST) and Clinician Reported Outcome Spine Trauma (AOSpine CROST). These tools hold promise, as useful instruments to measure the outcomes of spine trauma patients with and without neurological deficit, making it more feasible for clinical use as well. Treating surgeons around the world are encouraged to use the AOSpine PROST and AOSpine CROST in daily clinical practice and for research purposes to create and contribute to evidence-based and patient-centered care. Using the same outcome measures that are specifically developed and validated for traumatic spine injuries will allow us to compare the outcomes of various treatments in a valid and reproducible fashion. This contributes to a reduction of the ongoing controversies and providing the best treatments for our patients.
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Yazdanshenas Ghazwin M, Tavakoli SAH, Latifi S, Saberi H, Derakhshanrad N, Yekaninejad MS, Sadeghi M, Emami Razavi SH, Norouzi Javidan A, Ghodsi SM. Psychological defense mechanisms among individuals with SCI with adjustment disorder. J Spinal Cord Med 2017; 40:538-547. [PMID: 27077569 PMCID: PMC5815149 DOI: 10.1080/10790268.2016.1140389] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES The used psychological defense styles among individuals with spinal cord injury (SCI) with adjustment disorders (AJD) have not yet been described. In the present investigation, the prevalence of AJD among people with SCI has been estimated and the pattern of used defense styles has been identified. DESIGN Cross-sectional investigation. SETTING A tertiary rehabilitation center in Iran. PARTICIPANTS Individuals referred to Brain and Spinal Cord Injury Research Center were invited to participate in a screening interview. AJD was diagnosed based on DSM-V criteria. Those with AJD diagnosis were scheduled for another interview to assess defense mechanisms. OUTCOME MEASURES Demographic and injury-related variables were recorded. Defense mechanisms were assessed by the 40-item version of the Defense-Style Questionnaire (DSQ-40). RESULTS Among 114 participants, 32 (28%) were diagnosed with AJD among whom 23 subjects attended the second interview. Mean age and time since injury were 29.57 ± 9.29 years and 11.70 ± 6.34 months, respectively. The majority of patients were using idealization defense mechanism (91.3%). In the second and third place, passive aggression (87.0%) and somatization (82.6%) defense mechanisms were observed, respectively. Neurotic style was dominantly used (11.52 ± 2.26). Sex, marital status, educational level, cause of the injury and injury level were not related to defense style (P: 0.38, 0.69, 0.88, 0.73, and P: 0.32, respectively). CONCLUSION Prevalence of AJD is estimated to be 28% among individuals with SCI. The most prevalent defense style was neurotic and the dominant used defense mechanism was "idealization." The role of demographic and injury-related variables in determining the used defense mechanisms was insignificant.
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Affiliation(s)
- Manijeh Yazdanshenas Ghazwin
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran,Correspondence to: Manijeh Yazdanshenas Ghazwin, Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Imam Khomeini Complex Hospital, Keshavarz Boulevard, Gharib Street, PO. Box: 6114185, Tehran, Iran.
| | | | - Sahar Latifi
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hooshang Saberi
- Department of Neurosurgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazi Derakhshanrad
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mir Saeed Yekaninejad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Majid Sadeghi
- Psychiatric and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed-Hassan Emami Razavi
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Norouzi Javidan
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed-Mohammad Ghodsi
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Kaminski L, Cordemans V, Cernat E, M'Bra KI, Mac-Thiong JM. Functional Outcome Prediction after Traumatic Spinal Cord Injury Based on Acute Clinical Factors. J Neurotrauma 2017; 34:2027-2033. [DOI: 10.1089/neu.2016.4955] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ludovic Kaminski
- Service d'orthopédie et de traumatologie de l'appareil locomoteur, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Virginie Cordemans
- Computer Assisted and Robotic Surgery (CARS), Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium
| | - Eduard Cernat
- Central Military University Hospital “Dr. Carol Davila,” Bucharest, Romania
| | - Kouamé Innocent M'Bra
- Service d'orthopédie et de traumatologie, Centre Hospitalier Universitaire (CHU), Bouaké, Bouaké, Ivory Coast
| | - Jean-Marc Mac-Thiong
- Department of Surgery, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
- Department of Surgery, Hôpital du Sacré-cœur de Montréal, Montreal, Quebec, Canada
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Phrenic pacing compared with mechanical ventilation. Spinal Cord Ser Cases 2017; 3:17022. [PMID: 28503328 DOI: 10.1038/scsandc.2017.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/21/2017] [Accepted: 03/27/2017] [Indexed: 11/08/2022] Open
Abstract
STUDY DESIGN Comparable case series. OBJECTIVES High-cervical spinal cord injury (SCI) may disrupt the ability to breathe sufficiently. To restore respiration a phrenic nerve pacer can be implanted. The aims of this study were to describe the use of phrenic nerve pacing in tetraplegics in Denmark and compare the users with a population of ventilator dependent tetraplegics. SETTING Clinics for Spinal Cord Injuries, and Respiratory Centre East, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. METHODS Nine tetraplegic individuals who had implantation of a phrenic nerve pacer and 16 home mechanical ventilator dependent tetraplegics met the inclusion criteria. Data were retrieved from medical records and a structured follow-up interview with seven individuals from each group. RESULTS No significant differences were found when comparing age at injury, time since injury, length of hospitalization, incidence of pneumonia, number of pneumonia hospitalizations, number of tracheal suctions, speech quality and activities of daily living or quality of life. On the Short Form Health Survey (SF36) mental health summary the median for both users of phrenic nerve pacing and users of mechanical ventilation was one s.d. above the mean of a standard population. CONCLUSIONS Nine people have had a phrenic nerve pacer implanted. They do not significantly differ from a group of home mechanical ventilator dependent tetraplegics on a number of performance measures, but both groups seem to have better quality of life than a standard population.
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Misirlioglu TO, Unalan H, Karamehmetoglu SS. Validation of Duruöz Hand Index in patients with tetraplegia. J Hand Ther 2017; 29:269-74. [PMID: 26541579 DOI: 10.1016/j.jht.2015.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 10/02/2015] [Accepted: 10/02/2015] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Cross-sectional, clinical measurement. PURPOSE To investigate the validity of the Duruöz Hand Index (DHI) in the assessment of hand function in patients with tetraplegia. METHODS A total of 40 patients with tetraplegia participated. Patients' upper extremities were assessed on the level of 'body function and structure' [The American Spinal Cord Injury Association (ASIA) Impairment Scale (AIS) 2000 revised criteria, upper extremity motor score (UEMS), neurologic level of injury and visual analogue scale of hand function (VAS-HF)], 'activity' [DHI and Quadriplegia index of function-short form (QIF-SF)] and 'body function and structure, activity and participation' [Health Survey Short Form-36 (SF-36)] according to International Classification of Function. RESULTS The DHI showed significant correlations with UEMS, AIS, QIF-SF, VAS-HF, physical functioning and physical compound summary scores of SF-36. CONCLUSIONS The DHI was found a valid method in the assessment of hand functions in patients with tetraplegia. LEVEL OF EVIDENCE Diagnostic III.
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Affiliation(s)
| | - Halil Unalan
- Istanbul University, Cerrahpasa Medical Faculty, Department of Physical Medicine and Rehabilitation, Turkey
| | - Safak Sahir Karamehmetoglu
- Istanbul University, Cerrahpasa Medical Faculty, Department of Physical Medicine and Rehabilitation, Turkey
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Relevance of the international spinal cord injury basic data sets to youth: an Inter-Professional review with recommendations. Spinal Cord 2017; 55:875-881. [DOI: 10.1038/sc.2017.14] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 12/29/2016] [Accepted: 01/06/2017] [Indexed: 01/22/2023]
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Petersen JA, Spiess M, Curt A, Weidner N, Rupp R, Abel R, Schubert M. Upper Limb Recovery in Spinal Cord Injury: Involvement of Central and Peripheral Motor Pathways. Neurorehabil Neural Repair 2017; 31:432-441. [PMID: 28132610 DOI: 10.1177/1545968316688796] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVE The course of central and peripheral motor recovery after cervical spinal cord injury (SCI) may be investigated by electrophysiological measures. The goal of this study was to compare the 2 over the first year after injury in relation to motor gains. METHODS Compound motor action potentials (CMAPs), motor-evoked potentials (MEPs), and F-waves were recorded from the abductor digiti minimi and CMAP and F-waves from abductor hallucis muscles in 305 patients at about 15 days, 1 month, 3 months, 6 months, and 12 months following an acute traumatic SCI. RESULTS The MEP amplitudes and F-wave persistences were lower with more severe sensorimotor impairment. They steadily increased in most subgroups within 6 months after SCI. The amplitude of the CMAPs was low for the first 3 months in the most severely affected participants. This was also found for CMAPs from tibial nerve originating well below the cervical lesion level. Improvement in neurophysiological parameters correlated with improved upper extremity motor scores. CONCLUSION The results point to a systematic interrelation of corticospinal transmission, spinal motoneuron excitability, and its axon function, respectively. Electrophysiological correlates of neural excitability show distinct spatial and temporal interrelations within central and peripheral motor pathways following acute cervical SCI. A strong secondary deterioration within the peripheral motor system with incomplete or no recovery depends on anatomical distance caudal to lesion and on lesion severity. Electrophysiological assessments may increase the sensitivity of interventional studies in addition to clinical measures.
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Affiliation(s)
- Jens A Petersen
- 1 University Hospital Zurich, Zurich, Switzerland.,2 University of Zurich, Zurich, Switzerland.,3 University Hospital Balgrist, Zurich, Switzerland
| | | | - Armin Curt
- 3 University Hospital Balgrist, Zurich, Switzerland
| | | | - Rüdiger Rupp
- 4 Heidelberg University Hospital, Heidelberg, Germany
| | - Rainer Abel
- 5 Spinal Cord Injury Center, Bayreuth, Germany
| | -
- 3 University Hospital Balgrist, Zurich, Switzerland
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Majerus SJA, Fletter PC, Ferry EK, Zhu H, Gustafson KJ, Damaser MS. Suburothelial Bladder Contraction Detection with Implanted Pressure Sensor. PLoS One 2017; 12:e0168375. [PMID: 28060842 PMCID: PMC5218553 DOI: 10.1371/journal.pone.0168375] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/29/2016] [Indexed: 12/31/2022] Open
Abstract
Aims Managing bladder pressure in patients with neurogenic bladders is needed to improve rehabilitation options, avoid upper tract damage, incontinence, and their associated co-morbidities and mortality. Current methods of determining bladder contractions are not amenable to chronic or ambulatory settings. In this study we evaluated detection of bladder contractions using a novel piezoelectric catheter-free pressure sensor placed in a suburothelial bladder location in animals. Methods Wired prototypes of the pressure monitor were implanted into 2 nonsurvival (feline and canine) and one 13-day survival (canine) animal. Vesical pressures were obtained from the device in both suburothelial and intraluminal locations and simultaneously from a pressure sensing catheter in the bladder. Intravesical pressure was monitored in the survival animal over 10 days from the suburothelial location and necropsy was performed to assess migration and erosion. Results In the nonsurvival animals, the average correlation between device and reference catheter data was high during both electrically stimulated bladder contractions and manual compressions (r = 0.93±0.03, r = 0.89±0.03). Measured pressures correlated strongly (r = 0.98±0.02) when the device was placed in the bladder lumen. The survival animal initially recorded physiologic data, but later this deteriorated. However, endstage intraluminal device recordings correlated (r = 0.85±0.13) with the pressure catheter. Significant erosion of the implant through the detrusor was found. Conclusions This study confirms correlation between suburothelial pressure readings and intravesical bladder pressures. Due to device erosion during ambulatory studies, a wireless implant is recommended for clinical rehabilitation applications.
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Affiliation(s)
- Steve J. A. Majerus
- Advanced Pltatform Technology Center, Louis Stokes Veterans Affairs Medical Center, Cleveland, OH, United States of America
- Department of Electrical Engineering and Computer Sciences, Case Western Reserve University, Cleveland, OH, United States of America
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, United States of America
| | - Paul C. Fletter
- Advanced Pltatform Technology Center, Louis Stokes Veterans Affairs Medical Center, Cleveland, OH, United States of America
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, United States of America
| | - Elizabeth K. Ferry
- Division of Urology, Louis Stokes Veterans Affairs Medical Center, Cleveland, OH, United States of America
- Urology Institute, University Hospitals, Case Medical Center, Cleveland, OH, United States of America
| | - Hui Zhu
- Advanced Pltatform Technology Center, Louis Stokes Veterans Affairs Medical Center, Cleveland, OH, United States of America
- Division of Urology, Louis Stokes Veterans Affairs Medical Center, Cleveland, OH, United States of America
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland OH, United States of America
| | - Kenneth J. Gustafson
- Urology Institute, University Hospitals, Case Medical Center, Cleveland, OH, United States of America
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States of America
- Functional Electrical Stimulation Center, Louis Stokes Veterans Affairs Medical Center, Cleveland, OH, United States of America
| | - Margot S. Damaser
- Advanced Pltatform Technology Center, Louis Stokes Veterans Affairs Medical Center, Cleveland, OH, United States of America
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, United States of America
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland OH, United States of America
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States of America
- * E-mail:
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Outcome Measure Recommendations From the Spinal Cord Injury EDGE Task Force. Phys Ther 2016; 96:1832-1842. [PMID: 27231273 DOI: 10.2522/ptj.20150453] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 05/14/2016] [Indexed: 02/09/2023]
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85
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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] [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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86
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Nitsch KP, Stipp KL. Measurement Characteristics and Clinical Utility of the Spinal Cord Independence Measure-III Among Individuals With Spinal Cord Injury. Arch Phys Med Rehabil 2016. [DOI: 10.1016/j.apmr.2016.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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87
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Biering-Sørensen F, Noonan VK. Standardization of Data for Clinical Use and Research in Spinal Cord Injury. Brain Sci 2016; 6:E29. [PMID: 27529284 PMCID: PMC5039458 DOI: 10.3390/brainsci6030029] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 07/22/2016] [Accepted: 08/03/2016] [Indexed: 11/25/2022] Open
Abstract
Increased survival after spinal cord injury (SCI) worldwide has enhanced the need for quality data that can be compared and shared between centers, countries, as well as across research studies, to better understand how best to prevent and treat SCI. Such data should be standardized and be able to be uniformly collected at any SCI center or within any SCI study. Standardization will make it possible to collect information from larger SCI populations for multi-center research studies. With this aim, the international SCI community has obtained consensus regarding the best available data and measures for use in SCI clinical practice and research. Reporting of SCI data is likewise standardized. Data elements are continuously updated and developed using an open and transparent process. There are ongoing internal, as well as external review processes, where all interested parties are encouraged to participate. The purpose of this review paper is to provide an overview of the initiatives to standardize data including the International Spinal Cord Society's International SCI Data Sets and the National Institutes of Health, National Institute of Neurological Disorders and Stroke Common Data Elements Project within SCI and discuss future opportunities.
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Affiliation(s)
- Fin Biering-Sørensen
- Clinic for Spinal Cord Injuries, Rigshospitalet (2081), University of Copenhagen, Copenhagen DK-2100, Denmark.
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88
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Hill JN, Balbale S, Lones K, LaVela SL. Starting a new conversation: Engaging Veterans with spinal cord injury in discussions of what function means to them, the barriers/facilitators they encounter, and the adaptations they use to optimize function. Disabil Health J 2016; 10:114-122. [PMID: 27424945 DOI: 10.1016/j.dhjo.2016.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 05/17/2016] [Accepted: 05/30/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Assessments of function in persons with spinal cord injury (SCI) often utilize pre-defined constructs and measures without consideration of patient context, including how patients define function and what matters to them. OBJECTIVES/HYPOTHESIS We utilized photovoice to understand how individuals define function, facilitators and barriers to function, and adaptations to support functioning. METHODS Veterans with SCI were provided with cameras and guidelines to take photographs of things that: (1) help with functioning, (2) are barriers to function, and (3) represent adaptations used to support functioning. Interviews to discuss photographs followed and were audio-recorded, transcribed, and analyzed using grounded-thematic coding. Nvivo 8 was used to store and organize data. RESULTS Participants (n = 9) were male (89%), Caucasian (67%), had paraplegia (75%), averaged 64 years of age, and were injured, on average, for 22 years. Function was described in several ways: the concept of 'normalcy,' aspects of daily living, and ability to be independent. Facilitators included: helpful tools, physical therapy/therapists, transportation, and caregivers. Barriers included: wheelchair-related issues and interior/exterior barriers both in the community and in the hospital. Examples of adaptations included: traditional examples like ramps, and also creative examples like the use of rubber bands on a can to help with grip. CONCLUSION(S) Patient-perspectives elicited in-depth information that expanded the common definition of function by highlighting the concept of "normality," facilitators and barriers to function, and adaptations to optimize function. These insights emphasize function within a patient-context, emphasizing a holistic definition of function that can be used to develop personalized, patient-driven care plans.
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Affiliation(s)
- Jennifer N Hill
- Department of Veterans Affairs (VA), Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Edward Hines Jr. VA Hospital, Hines, IL, USA; Center of Innovation for Complex Chronic Health Care (CINCCH), Edward Hines Jr. VA Hospital, Hines, IL, USA; Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Edward Hines Jr. VA Hospital, Hines, IL, USA.
| | - Salva Balbale
- Department of Veterans Affairs (VA), Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Edward Hines Jr. VA Hospital, Hines, IL, USA; Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Edward Hines Jr. VA Hospital, Hines, IL, USA; Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Keshonna Lones
- Department of Veterans Affairs (VA), Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Edward Hines Jr. VA Hospital, Hines, IL, USA; Center of Innovation for Complex Chronic Health Care (CINCCH), Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Sherri L LaVela
- Department of Veterans Affairs (VA), Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Edward Hines Jr. VA Hospital, Hines, IL, USA; Center of Innovation for Complex Chronic Health Care (CINCCH), Edward Hines Jr. VA Hospital, Hines, IL, USA; Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Edward Hines Jr. VA Hospital, Hines, IL, USA; Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University, Chicago, IL, USA
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89
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Talekar K, Poplawski M, Hegde R, Cox M, Flanders A. Imaging of Spinal Cord Injury: Acute Cervical Spinal Cord Injury, Cervical Spondylotic Myelopathy, and Cord Herniation. Semin Ultrasound CT MR 2016; 37:431-47. [PMID: 27616315 DOI: 10.1053/j.sult.2016.05.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We review the pathophysiology and imaging findings of acute traumatic spinal cord injury (SCI), cervical spondylotic myelopathy, and briefly review the much less common cord herniation as a unique cause of myelopathy. Acute traumatic SCI is devastating to the patient and the costs to society are staggering. There are currently no "cures" for SCI and the only accepted pharmacologic treatment regimen for traumatic SCI is currently being questioned. Evaluation and prognostication of SCI is a demanding area with significant deficiencies, including lack of biomarkers. Accurate classification of SCI is heavily dependent on a good clinical examination, the results of which can vary substantially based upon the patient׳s condition or comorbidities and the skills of the examiner. Moreover, the full extent of a patients׳ neurologic injury may not become apparent for days after injury; by then, therapeutic response may be limited. Although magnetic resonance imaging (MRI) is the best imaging modality for the evaluation of spinal cord parenchyma, conventional MR techniques do not appear to differentiate edema from axonal injury. Recently, it is proposed that in addition to characterizing the anatomic extent of injury, metrics derived from conventional MRI and diffusion tensor imaging, in conjunction with the neurological examination, can serve as a reliable objective biomarker for determination of the extent of neurologic injury and early identification of patients who would benefit from treatment. Cervical spondylosis is a common disorder affecting predominantly the elderly with a potential to narrow the spinal canal and thereby impinge or compress upon the neural elements leading to cervical spondylotic myelopathy and radiculopathy. It is the commonest nontraumatic cause of spinal cord disorder in adults. Imaging plays an important role in grading the severity of spondylosis and detecting cord abnormalities suggesting myelopathy.
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Affiliation(s)
- Kiran Talekar
- Section of Neuroradiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
| | - Michael Poplawski
- Department of Radiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Rahul Hegde
- Section of Neuroradiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Mougnyan Cox
- Department of Radiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Adam Flanders
- Section of Neuroradiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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90
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Voxel-based analysis of grey and white matter degeneration in cervical spondylotic myelopathy. Sci Rep 2016; 6:24636. [PMID: 27095134 PMCID: PMC4837346 DOI: 10.1038/srep24636] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 04/04/2016] [Indexed: 12/21/2022] Open
Abstract
In this prospective study, we made an unbiased voxel-based analysis to investigate above-stenosis spinal degeneration and its relation to impairment in patients with cervical spondylotic myelopathy (CSM). Twenty patients and 18 controls were assessed with high-resolution MRI protocols above the level of stenosis. Cross-sectional areas of grey matter (GM), white matter (WM), and posterior columns (PC) were measured to determine atrophy. Diffusion indices assessed tract-specific integrity of PC and lateral corticospinal tracts (CST). Regression analysis was used to reveal relationships between MRI measures and clinical impairment. Patients showed mainly sensory impairment. Atrophy was prominent within the cervical WM (13.9%, p = 0.004), GM (7.2%, p = 0.043), and PC (16.1%, p = 0.005). Fractional anisotropy (FA) was reduced in the PC (−11.98%, p = 0.006) and lateral CST (−12.96%, p = 0.014). In addition, radial (+28.47%, p = 0.014), axial (+14.72%, p = 0.005), and mean (+16.50%, p = 0.001) diffusivities were increased in the PC. Light-touch score was associated with atrophy (R2 = 0.3559, p = 0.020) and FA (z score 3.74, p = 0.003) in the PC, as was functional independence and FA in the lateral CST (z score 3.68, p = 0.020). This study demonstrates voxel-based degeneration far above the stenosis at a level not directly affected by the compression and provides unbiased readouts of tract-specific changes that relate to impairment.
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91
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Barbonetti A, Sperandio A, Micillo A, D'Andrea S, Pacca F, Felzani G, Francavilla S, Francavilla F. Independent Association of Vitamin D With Physical Function in People With Chronic Spinal Cord Injury. Arch Phys Med Rehabil 2016; 97:726-32. [PMID: 26805770 DOI: 10.1016/j.apmr.2016.01.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 11/27/2015] [Accepted: 01/01/2016] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To explore the relation between vitamin D and physical function outcomes in people with spinal cord injury (SCI). DESIGN Cross-sectional study. SETTING Rehabilitation institute. PARTICIPANTS Consecutive patients (N=100; 72 men and 28 women) with chronic SCI admitted to a rehabilitation program. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Functional independence in activities of daily living (ADL) and leisure time physical activity (LTPA) were assessed as measures of physical function. RESULTS Vitamin D deficiency (<20ng/mL) was found in 78 patients: they exhibited a significantly higher body mass index, lower functional independence in ADL, and were engaged in a significantly poorer weekly LTPA. At the linear multiple regression analysis, lower 25-hydroxyvitamin D levels showed significant independent associations with poorer functional independence in ADL (β=.59; 95% confidence interval, .36-.82; P<.0001) and with poorer LTPA (β=2.35; 95% confidence interval, 0.77-3.94; P=.004), after adjustment for other predictors of physical function outcomes selected by univariate analyses. CONCLUSIONS In people with chronic SCI, a low vitamin D level represents an independent predictor of poor physical function.
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Affiliation(s)
- Arcangelo Barbonetti
- Andrology Unit, Department of Life, Health and Environment Sciences, University of L'Aquila, L'Aquila, Italy; Spinal Unit, San Raffaele Sulmona Institute, Sulmona, Italy.
| | - Alessandra Sperandio
- Andrology Unit, Department of Life, Health and Environment Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alessandro Micillo
- Andrology Unit, Department of Life, Health and Environment Sciences, University of L'Aquila, L'Aquila, Italy
| | - Settimio D'Andrea
- Andrology Unit, Department of Life, Health and Environment Sciences, University of L'Aquila, L'Aquila, Italy
| | - Federica Pacca
- Spinal Unit, San Raffaele Sulmona Institute, Sulmona, Italy
| | | | - Sandro Francavilla
- Andrology Unit, Department of Life, Health and Environment Sciences, University of L'Aquila, L'Aquila, Italy
| | - Felice Francavilla
- Andrology Unit, Department of Life, Health and Environment Sciences, University of L'Aquila, L'Aquila, Italy
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92
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Joseph C, Phillips J, Wahman K, Nilsson Wikmar L. Mapping two measures to the International Classification Of Functioning, Disability and Health and the brief ICF core set for spinal cord injury in the post-acute context. Disabil Rehabil 2016; 38:1730-8. [PMID: 26750300 DOI: 10.3109/09638288.2015.1107762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the extent to which the rehabilitation outcome levels (ROL) and the spinal cord independence measure (SCIM) III could be mapped to the International Classification of Functioning, Disability and Health (ICF) and the brief core set for spinal cord injury (SCI) in the post-acute context. METHODS Two professionals used the published protocol to map the concepts derived from both measures to the ICF categories. Further, the endorsed categories at the second level of the ICF were used to determine the coverage of the Brief ICF Core Set for SCI. RESULTS Three items of the ROL could not be conceptualised within the ICF, while the rest were mapped to 42 second-level categories, mainly to the activity and participation domain. All the items of the SCIM III were mapped, yielding 52 ICF categories, mostly at the third level (32). For the mapping to the Core Set for SCI, the ROL covered five and the SCIM III all nine categories of 'activities and participation' included as the candidate categories of the brief version. CONCLUSION In terms of content, the ROL appears to be a more global measure of functioning, compared with the SCIM III that covers specific 'activity' aspects as proposed in the Brief Core Set for SCI. It is thus recommended that standardised measures, such as the SCIM III, be used due to its conceptual underpinnings and coverage of important aspects. Implications for Rehabilitation Rehabilitation professionals should select appropriately validated outcome measures specific to the health condition in order to evaluate the effectiveness of rehabilitation. Rehabilitation professional working with outcome measures should be aware of the limitations of measures, in terms of content, and supplement the evaluation with appropriate standardised measures or the use of the Core Sets. To enhance evidence-based practise in routine clinical practise, standardised outcome measures should be used.
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Affiliation(s)
- Conran Joseph
- a Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society , Karolinska Institutet , Stockholm , Sweden
| | - Julie Phillips
- b Physiotherapy Department , University of the Western Cape , Cape Town , South Africa
| | - Kerstin Wahman
- c Division of Neurodegeneration, Section Neurorehabilitation, Department of Neurobiology, Care Sciences and Society , Karolinska Institutet , Stockholm , Sweden ;,d Rehab Station Stockholm/Spinalis R&D Unit , Stockholm , Sweden
| | - Lena Nilsson Wikmar
- a Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society , Karolinska Institutet , Stockholm , Sweden
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93
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Fortin CD, Voth J, Jaglal SB, Craven BC. Inpatient rehabilitation outcomes in patients with malignant spinal cord compression compared to other non-traumatic spinal cord injury: A population based study. J Spinal Cord Med 2015; 38:754-64. [PMID: 25615237 PMCID: PMC4725809 DOI: 10.1179/2045772314y.0000000278] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To compare and describe demographic characteristics, clinical, and survival outcomes in patients admitted for inpatient rehabilitation following malignant spinal cord compression (MSCC) or other causes of non-traumatic spinal cord injury (NT-SCI). DESIGN A retrospective cohort design was employed, using data retrieved from administrative databases. SETTING Rehabilitation facilities or designated rehabilitation beds in Ontario, Canada, from April 2007 to March 2011. PARTICIPANTS Patients with incident diagnoses of MSCC (N = 143) or NT-SCI (N = 1,274) admitted for inpatient rehabilitation. OUTCOME MEASURES Demographic, impairment, functional outcome (as defined by the Functional Independence Measure (FIM)), discharge, healthcare utilization, survival, and tumor characteristics. RESULTS There was a significant improvement in the FIM from admission to discharge (mean change 20.1 ± 14.3, <0.001) in the MSCC cohort. NT-SCI patients demonstrated a higher FIM efficiency (1.2 ± 1.7 vs. 0.8 ± 0.8, <0.001) and higher total (24.0 ± 14.4 vs. 20.1 ± 14.3, <0.001) FIM gains relative to MSCC cases. However, there were no differences between the MSCC and NT-SCI cohorts in length of stay (34.6 ± 30.3 vs. 37.5 ± 35.2, P = 0.8) or discharge FIM (100.7 ± 19.6 vs. 103.3 ± 18.1, P = 0.1). Three-month, 1-year, and 3-year survival rates in the MSCC and NT-SCI cohorts were 76.2% vs. 97.6%, 46.2% vs. 93.7%, and 27.3% vs. 86.7%, respectively. The majority (65.0%) of patients with MSCC was discharged home and met their rehabilitation goals (75.5%) at comparable rates to patients with NT-SCI (69.7 and 81.3%). CONCLUSION Despite compromised survival, patients with MSCC make clinically significant functional gains and exhibit favorable discharge outcomes following inpatient rehabilitation. Current administrative data suggests the design and scope of inpatient rehabilitation services should reflect the unique survival-related prognostic factors in patients with MSCC.
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Affiliation(s)
| | - Jennifer Voth
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | | | - B. Catharine Craven
- Correspondence to: B. Catharine Craven, Toronto Rehabilitation Institute, Lyndhurst Centre, 520 Sutherland Drive, Toronto, ON M4G 3V9, Canada.
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94
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Post MW, Charlifue S, Biering-Sørensen F, Catz A, Dijkers MP, Horsewell J, Noonan VK, Noreau L, Tate DG, Sinnott KA. Development of the International Spinal Cord Injury Activities and Participation Basic Data Set. Spinal Cord 2015; 54:530-4. [PMID: 26481708 DOI: 10.1038/sc.2015.188] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 05/23/2015] [Accepted: 05/27/2015] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Consensus decision-making process. OBJECTIVES The objective of this study was to develop an International Spinal Cord Injury (SCI) Activities and Participation (A&P) Basic Data Set. SETTING International working group. METHODS A committee of experts was established to select and define A&P data elements to be included in this data set. A draft data set was developed and posted on the International Spinal Cord Society (ISCoS) and American Spinal Injury Association websites and was also disseminated among appropriate organizations for review. Suggested revisions were considered, and a final version of the A&P Data Set was completed. RESULTS Consensus was reached to define A&P and to incorporate both performance and satisfaction ratings. Items that were considered core to each A&P domain were selected from two existing questionnaires. Four items measuring activities were selected from the Spinal Cord Independence Measure III to provide basic data on task execution in activities of daily living. Eight items were selected from the Craig Handicap Assessment and Reporting Technique to provide basic data on the frequency of participation. An additional rating of satisfaction on a three-point scale for each item completes the total of 24 A&P variables. CONCLUSION Collection of the International SCI A&P Basic Data Set variables in all future research on SCI outcomes is advised to facilitate comparison of results across published studies from around the world. Additional standardised instruments to assess activities of daily living or participation can be administered, depending on the purpose of a particular study.
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Affiliation(s)
- M W Post
- Brain Center Rudolf Magnus and Center of Excellence in Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation Centre, Utrecht, The Netherlands.,Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - F Biering-Sørensen
- Department for Spinal Cord Injuries, Rigshospitalet and Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark
| | - A Catz
- Loewenstein Rehabilitation Hospital, Raanana, and Tel-Aviv University, Tel-Aviv, Israel
| | - M P Dijkers
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Horsewell
- The European Spinal Cord Injury Federation, Copenhagen, Denmark
| | - V K Noonan
- The Rick Hansen Institute, Vancouver, BC, Canada
| | - L Noreau
- Université Laval and Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, QC, Canada
| | - D G Tate
- University of Michigan, Department of Physical Medicine and Rehabilitation, Ann Arbor, MI, USA
| | - K A Sinnott
- Burwood Academy of Independent Living, Christchurch, New Zealand
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95
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Bonavita J, Torre M, China S, Bressi F, Bonatti E, Capirossi R, Tiberti S, Olivi S, Musumeci G, Maietti E, Fekete C, Baroncini I, Brinkhof MWG, Molinari M, Scivoletto G. Validation of the Italian version of the Spinal Cord Independence Measure (SCIM III) Self-Report. Spinal Cord 2015; 54:553-60. [PMID: 26481705 DOI: 10.1038/sc.2015.187] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/02/2015] [Accepted: 09/15/2015] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional validation study. OBJECTIVES To validate the Italian version of the Spinal Cord Independence Measure Self-Report (SCIM SR). SETTING Two spinal cord injury (SCI) rehabilitation facilities in Italy. METHODS The SCIM III comprises items on 19 daily tasks, grouped into three subscales: 'Self-care,' 'Respiration and sphincter management' and 'Mobility'. The total SCIM score ranges between 0 and 100. The Italian self-reported version (SCIM SR) was translated from the German tool. We studied 116 patients on their first hospitalization for rehabilitation after an SCI. At the time of discharge, patients were evaluated by the rehabilitation team using the SCIM III and self-assessed their independence with regard to activities of daily living using the SCIM SR. Pearson's correlation, Bland-Altman method, and stratified and regression analyses were used to examine the differences between evaluations. RESULTS On the basis of Pearson's correlation, there was good agreement between the data from the SCIM III and SCIM SR (r=0.918 for 'Self-care,' 0.806 for 'Respiration and sphincter management,' 0.906 for 'Mobility' and 0.934 for total scores). By Bland-Altman analysis, patients rated their functioning nearly the same as professionals-the mean difference between SCIM III and SCIM SR scores was approximately 0 for all subscales and total scores. The stratified and regression analyses failed to identify any specific factor that was associated with differences between SCIM III and SCIM SR scores. CONCLUSIONS These results support the validity of the Italian version of the SCIM SR, which can facilitate longer-term evaluations of the independence of individuals with SCIs.
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Affiliation(s)
- J Bonavita
- Montecatone Rehabilitation Institute, Imola, Italy
| | - M Torre
- Spinal Unit, IRCCS S. Lucia Foundation, Rome, Italy.,Spinal Rehabilitation (SpiRe) Laboratory, IRCCS S. Lucia Foundation, Rome, Italy
| | - S China
- Montecatone Rehabilitation Institute, Imola, Italy
| | - F Bressi
- Department of Rehabilitation Medicine, Università Campus Bio-Medico, Rome, Italy
| | - E Bonatti
- Montecatone Rehabilitation Institute, Imola, Italy
| | - R Capirossi
- Montecatone Rehabilitation Institute, Imola, Italy
| | - S Tiberti
- Spinal Unit, IRCCS S. Lucia Foundation, Rome, Italy
| | - S Olivi
- Montecatone Rehabilitation Institute, Imola, Italy
| | - G Musumeci
- Montecatone Rehabilitation Institute, Imola, Italy
| | - E Maietti
- Montecatone Rehabilitation Institute, Imola, Italy
| | - C Fekete
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - I Baroncini
- Montecatone Rehabilitation Institute, Imola, Italy
| | - M W G Brinkhof
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - M Molinari
- Spinal Unit, IRCCS S. Lucia Foundation, Rome, Italy.,Spinal Rehabilitation (SpiRe) Laboratory, IRCCS S. Lucia Foundation, Rome, Italy
| | - G Scivoletto
- Spinal Unit, IRCCS S. Lucia Foundation, Rome, Italy.,Spinal Rehabilitation (SpiRe) Laboratory, IRCCS S. Lucia Foundation, Rome, Italy
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96
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MERGHATI KHOI E, LATIFI S, RAHDARI F, SHAKERI H, ARMAN F, KOUSHKI D, NOROUZI JAVIDAN A, TAHERI OTAGHSARA SM. The Effect of Injury-Related Characteristics on Changes in Marital Status after Spinal Cord Injury. IRANIAN JOURNAL OF PUBLIC HEALTH 2015; 44:1395-402. [PMID: 26576353 PMCID: PMC4644585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Spinal cord injury (SCI) imposes a significant burden on the social and marital life. Here, we assessed the divorce rate and changes in marital status among a sample of Iranian individuals with SCI. METHODS Referred patients to Brain and Spinal Cord Injury Research Center were invited to participate in this cross-sectional investigation. The Main exclusion criteria were coincidental brain injury, history of chronic diseases before SCI and substance use. Demographic characteristics (including age, gender, educational level, marital status before and after injury and duration of marriage) and Injury characteristics (level of the injury, American spinal injury association (ASIA) scale and Spinal cord independence measure III (SCIM)) were collected. RESULTS Total of 241 subjects with SCI participated in this investigation (164 (68%) male and 77 (32%) female). Among men, 16.5% [95% CI: 10.81%-22.18%] and among women 18.2% [95% CI: 9.58%-26.81%] got divorced after injury. Duration of marriage before injury was significantly related to lower divorce rate (P< 0.001 and 0.016 in men and women, respectively). Injury characteristics had no relationship with marital longevity. Age was a protective factor against marital dissolution only in men (P< 0.004). CONCLUSION Our study revealed the divorce rate of 17% [95% CI: 13%-20.9%] after SCI in a sample of Iranian population. The protective influence of age in maintenance of marriage was only detected in men, which proposes existence of a sexual polymorphism in the role of age. Divorce rate was similar between two genders and injury characteristics were not related to divorce rate as well.
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Affiliation(s)
- Effat MERGHATI KHOI
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar LATIFI
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereshteh RAHDARI
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran,Corresponding Author:
| | - Hania SHAKERI
- Dept. of Psychiatry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Farid ARMAN
- Dept. of Psychiatry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Abbas NOROUZI JAVIDAN
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Grabher P, Callaghan MF, Ashburner J, Weiskopf N, Thompson AJ, Curt A, Freund P. Tracking sensory system atrophy and outcome prediction in spinal cord injury. Ann Neurol 2015; 78:751-61. [PMID: 26290444 PMCID: PMC4737098 DOI: 10.1002/ana.24508] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 08/17/2015] [Accepted: 08/18/2015] [Indexed: 11/17/2022]
Abstract
Objective In patients with subacute spinal cord injury (SCI), the motor system undergoes progressive structural changes rostral to the lesion, which are associated with motor outcome. The extent to which the sensory system is affected and how this relates to sensory outcome are uncertain. Methods Changes in the sensory system were prospectively followed by applying a comprehensive magnetic resonance imaging (MRI) protocol to 14 patients with subacute traumatic SCI at baseline, 2 months, 6 months, and 12 months after injury, combined with a full neurological examination and comprehensive pain assessment. Eighteen controls underwent the same MRI protocol. T1‐weighted volumes, myelin‐sensitive magnetization transfer saturation (MT), and longitudinal relaxation rate (R1) mapping provided data on spinal cord and brain morphometry and microstructure. Regression analysis assessed the relationship between MRI readouts and sensory outcomes. Results At 12 months from baseline, sensory scores were unchanged and below‐level neuropathic pain became prominent. Compared with controls, patients showed progressive degenerative changes in cervical cord and brain morphometry across the sensory system. At 12 months, MT and R1 were reduced in areas of structural decline. Sensory scores at 12 months correlated with rate of change in cord area and brain volume and decreased MT in the spinal cord at 12 months. Interpretation This study has demonstrated progressive atrophic and microstructural changes across the sensory system with a close relation to sensory outcome. Structural MRI protocols remote from the site of lesion provide new insights into neuronal degeneration underpinning sensory disturbance and have potential as responsive biomarkers of rehabilitation and treatment interventions. Ann Neurol 2015;78:Ann Neurol 2015;78:679–696
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Affiliation(s)
- Patrick Grabher
- Spinal Cord Injury Center Balgrist, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martina F Callaghan
- Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, University College London, London, United Kingdom
| | - John Ashburner
- Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Nikolaus Weiskopf
- Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, University College London, London, United Kingdom.,Department of Neurophysics, Max Planck Institute for Human Cognitive, and Brain Sciences, Leipzig, Germany
| | - Alan J Thompson
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, United Kingdom
| | - Armin Curt
- Spinal Cord Injury Center Balgrist, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Patrick Freund
- Spinal Cord Injury Center Balgrist, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, University College London, London, United Kingdom.,Department of Neurophysics, Max Planck Institute for Human Cognitive, and Brain Sciences, Leipzig, Germany.,Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, United Kingdom
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98
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Mateo S, Di Rienzo F, Bergeron V, Guillot A, Collet C, Rode G. Motor imagery reinforces brain compensation of reach-to-grasp movement after cervical spinal cord injury. Front Behav Neurosci 2015; 9:234. [PMID: 26441568 PMCID: PMC4566051 DOI: 10.3389/fnbeh.2015.00234] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/19/2015] [Indexed: 01/19/2023] Open
Abstract
Individuals with cervical spinal cord injury (SCI) that causes tetraplegia are challenged with dramatic sensorimotor deficits. However, certain rehabilitation techniques may significantly enhance their autonomy by restoring reach-to-grasp movements. Among others, evidence of motor imagery (MI) benefits for neurological rehabilitation of upper limb movements is growing. This literature review addresses MI effectiveness during reach-to-grasp rehabilitation after tetraplegia. Among articles from MEDLINE published between 1966 and 2015, we selected ten studies including 34 participants with C4 to C7 tetraplegia and 22 healthy controls published during the last 15 years. We found that MI of possible non-paralyzed movements improved reach-to-grasp performance by: (i) increasing both tenodesis grasp capabilities and muscle strength; (ii) decreasing movement time (MT), and trajectory variability; and (iii) reducing the abnormally increased brain activity. MI can also strengthen motor commands by potentiating recruitment and synchronization of motoneurons, which leads to improved recovery. These improvements reflect brain adaptations induced by MI. Furthermore, MI can be used to control brain-computer interfaces (BCI) that successfully restore grasp capabilities. These results highlight the growing interest for MI and its potential to recover functional grasping in individuals with tetraplegia, and motivate the need for further studies to substantiate it.
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Affiliation(s)
- Sébastien Mateo
- ImpAct Team, Lyon Neuroscience Research Center, Université Lyon 1, Université de Lyon, INSERM U1028, CNRS UMR5292 Lyon, France ; Hospices Civils de Lyon, Hôpital Henry Gabrielle, Plateforme Mouvement et Handicap Lyon, France ; Centre de Recherche et d'Innovation sur le Sport, EA 647, Performance Motrice, Mentale et du Matériel, Université Lyon 1, Université de Lyon Villeurbanne, France ; Ecole Normale Supérieure de Lyon, CNRS UMR5672 Lyon, France
| | - Franck Di Rienzo
- Centre de Recherche et d'Innovation sur le Sport, EA 647, Performance Motrice, Mentale et du Matériel, Université Lyon 1, Université de Lyon Villeurbanne, France
| | - Vance Bergeron
- Ecole Normale Supérieure de Lyon, CNRS UMR5672 Lyon, France
| | - Aymeric Guillot
- Centre de Recherche et d'Innovation sur le Sport, EA 647, Performance Motrice, Mentale et du Matériel, Université Lyon 1, Université de Lyon Villeurbanne, France ; Institut Universitaire de France Paris, France
| | - Christian Collet
- Centre de Recherche et d'Innovation sur le Sport, EA 647, Performance Motrice, Mentale et du Matériel, Université Lyon 1, Université de Lyon Villeurbanne, France
| | - Gilles Rode
- ImpAct Team, Lyon Neuroscience Research Center, Université Lyon 1, Université de Lyon, INSERM U1028, CNRS UMR5292 Lyon, France ; Hospices Civils de Lyon, Hôpital Henry Gabrielle, Plateforme Mouvement et Handicap Lyon, France
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Tester NJ, Lorenz DJ, Suter SP, Buehner JJ, Falanga D, Watson E, Velozo CA, Behrman AL, Michele Basso D. Responsiveness of the Neuromuscular Recovery Scale During Outpatient Activity-Dependent Rehabilitation for Spinal Cord Injury. Neurorehabil Neural Repair 2015; 30:528-38. [PMID: 26359344 DOI: 10.1177/1545968315605181] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The Neuromuscular Recovery Scale (NRS) was developed by researchers and clinicians to functionally classify people with spinal cord injury (SCI) by measuring functionally relevant motor tasks without compensation. Previous studies established strong interrater and test-retest reliability and validity of the scale. OBJECTIVE To determine responsiveness of the NRS, a version including newly added upper-extremity items, in an outpatient rehabilitation setting. METHODS Assessments using the NRS and 6 other instruments were conducted at enrollment and discharge from a locomotor training program for 72 outpatients with SCI classified as American Spinal Injury Association Impairment Scale grades A to D (International Standards for Neurological Classification of Spinal Cord Injury). Mixed-model t statistics for instruments were calculated and adjusted for confounding factors (eg, sample size, demographic variables) for all patients and subgroups stratified by injury level and/or severity. The resulting adjusted response means (ARMs) and 95% confidence intervals (CIs) were used to determine responsiveness, and significant differences between instruments were identified with pairwise comparisons. RESULTS The NRS was significantly responsive for SCI outpatients (ARM = 1.05; CI = 0.75-1.35). Changes in motor function were detected across heterogeneous groups. Regardless of injury level or severity, the responsiveness of the NRS was equal to, and often significantly exceeded, the responsiveness of other instruments. CONCLUSIONS The NRS is a responsive measure that detects change in motor function during outpatient neurorehabilitation for SCI. There is potential utility for its application in randomized controlled trials and as a measure of clinical recovery across diverse SCI populations.
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Affiliation(s)
- Nicole J Tester
- Malcom Randall Veterans Affairs Medical Center, Gainesville, FL, USA University of Florida, Gainesville, FL, USA
| | | | | | | | | | | | - Craig A Velozo
- Medical University of South Carolina, Charleston, SC, USA
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100
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Behrman AL, Velozo C, Suter S, Lorenz D, Basso DM. Test-Retest Reliability of the Neuromuscular Recovery Scale. Arch Phys Med Rehabil 2015; 96:1375-84. [DOI: 10.1016/j.apmr.2015.03.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 01/23/2015] [Accepted: 03/05/2015] [Indexed: 11/30/2022]
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