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Draganich C, Anderson D, Dornan GJ, Sevigny M, Berliner J, Charlifue S, Welch A, Smith A. Predictive modeling of ambulatory outcomes after spinal cord injury using machine learning. Spinal Cord 2024:10.1038/s41393-024-01008-2. [PMID: 38890506 DOI: 10.1038/s41393-024-01008-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/12/2024] [Accepted: 06/06/2024] [Indexed: 06/20/2024]
Abstract
STUDY DESIGN Retrospective multi-site cohort study. OBJECTIVES To develop an accurate machine learning predictive model using predictor variables from the acute rehabilitation period to determine ambulatory status in spinal cord injury (SCI) one year post injury. SETTING Model SCI System (SCIMS) database between January 2000 and May 2019. METHODS Retrospective cohort study using data that were previously collected as part of the SCI Model System (SCIMS) database. A total of 4523 patients were analyzed comparing traditional models (van Middendorp and Hicks) compared to machine learning algorithms including Elastic Net Penalized Logistic Regression (ENPLR), Gradient Boosted Machine (GBM), and Artificial Neural Networks (ANN). RESULTS Compared with GBM and ANN, ENPLR was determined to be the preferred model based on predictive accuracy metrics, calibration, and variable selection. The primary metric to judge discrimination was the area under the receiver operating characteristic curve (AUC). When compared to the van Middendorp all patients (0.916), ASIA A and D (0.951) and ASIA B and C (0.775) and Hicks all patients (0.89), ASIA A and D (0.934) and ASIA B and C (0.775), ENPLR demonstrated improved AUC for all patients (0.931), ASIA A and D (0.965) ASIA B and C (0.803). CONCLUSIONS Utilizing artificial intelligence and machine learning methods are feasible for accurately classifying outcomes in SCI and may provide improved sensitivity in identifying which individuals are less likely to ambulate and may benefit from augmentative strategies, such as neuromodulation. Future directions should include the use of additional variables to further refine these models.
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Affiliation(s)
- Christina Draganich
- University of Colorado Department of Physical Medicine and Rehabilitation, Aurora, CO, USA.
| | | | | | | | - Jeffrey Berliner
- University of Colorado Department of Physical Medicine and Rehabilitation, Aurora, CO, USA
- Craig Hospital, Englewood, CO, USA
| | | | | | - Andrew Smith
- University of Colorado Department of Physical Medicine and Rehabilitation, Aurora, CO, USA
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Okayasu H, Hayashi T, Yokota K, Kawano O, Sakai H, Morishita Y, Masuda M, Kubota K, Ito H, Maeda T. Temporal dynamics of gait function in acute cervical spinal cord injury. BMC Musculoskelet Disord 2024; 25:430. [PMID: 38831297 PMCID: PMC11145767 DOI: 10.1186/s12891-024-07551-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/28/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Following spinal cord injury (SCI), gait function reaches a post-recovery plateau that depends on the paralysis severity. However, the plateau dynamics during the recovery period are not known. This study aimed to examine the gait function temporal dynamics after traumatic cervical SCI (CSCI) based on paralysis severity. METHODS This retrospective cohort study included 122 patients with traumatic CSCI admitted to a single specialized facility within 2 weeks after injury. The Walking Index for Spinal Cord Injury II (WISCI II) was estimated at 2 weeks and 2, 4, 6, and 8 months postinjury for each American Spinal Injury Association Impairment Scale (AIS) grade, as determined 2 weeks postinjury. Statistical analysis was performed at 2 weeks to 2 months, 2-4 months, 4-6 months, and 6-8 months, and the time at which no significant difference was observed was considered the time at which the gait function reached a plateau. RESULTS In the AIS grade A and B groups, no significant differences were observed at any time point, while in the AIS grade C group, the mean WISCI II values continued to significantly increase up to 6 months. In the AIS grade D group, the improvement in gait function was significant during the entire observation period. CONCLUSIONS The plateau in gait function recovery was reached at 2 weeks postinjury in the AIS grade A and B groups and at 6 months in the AIS grade C group.
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Affiliation(s)
- Hiroki Okayasu
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan.
- Department of Orthopaedic Surgery, Asahikawa Medical University, 2-1-1-1, Midorigaoka Higashi, Asahikawa, Hokkaido, 78-8510, Japan.
| | - Tetsuo Hayashi
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
- Department of Rehabilitation Medicine, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
| | - Kazuya Yokota
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
| | - Osamu Kawano
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
| | - Hiroaki Sakai
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
| | - Yuichiro Morishita
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
| | - Muneaki Masuda
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
| | - Kensuke Kubota
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
- Department of Rehabilitation Medicine, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
| | - Hiroshi Ito
- Department of Orthopaedic Surgery, Asahikawa Medical University, 2-1-1-1, Midorigaoka Higashi, Asahikawa, Hokkaido, 78-8510, Japan
| | - Takeshi Maeda
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
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Juszczak M, Shem K, Elliott CS. The Role of Upper Extremity Motor Function in the Choice of Bladder Management in Those Unable to Volitionally Void due to Neurologic Dysfunction. Urol Clin North Am 2024; 51:263-275. [PMID: 38609198 DOI: 10.1016/j.ucl.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
It is estimated that 425,000 individuals with neurologic bladder dysfunction (spinal cordinjury, spina bifida and multiple sclerosis) are unable to volitionally void and must rely oncatheter drainage. Upper extremity (UE) motor function is one of the most important factors indetermining the type of bladder management chosen in individuals who cannot volitionally void. Novel bladder management solutions for those with impaired UE motor function and concurrent impairments involitional voiding continue to be an area of need. Those with poor UE motor function more often choose an indwelling catheter, whereas those with normal UE motor function more often choose clean intermittent catheterization.
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Affiliation(s)
- Michael Juszczak
- Department of Physical Medicine and Rehabilitation, Tower Health, Reading Hospital Rehabilitation at Wyomissing, Reading, PA 19610, USA
| | - Kazuko Shem
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA 95128, USA
| | - Christopher S Elliott
- Division of Urology, Department of Urology, Stanford University Medical Center, Santa Clara Valley Medical Center, Valley Specialties Center-Division of Urology, 4th Floor, 751 South Bascom Avenue, San Jose, CA 95128, USA.
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Wan KR, Ng ZYV, Wee SK, Fatimah M, Lui W, Phua MW, So QYR, Maszczyk TK, Premchand B, Saffari SE, Ker RXJ, Ng WH. Recovery of Volitional Motor Control and Overground Walking in Participants With Chronic Clinically Motor Complete Spinal Cord Injury: Restoration of Rehabilitative Function With Epidural Spinal Stimulation (RESTORES) Trial-A Preliminary Study. J Neurotrauma 2024; 41:1146-1162. [PMID: 38115642 DOI: 10.1089/neu.2023.0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
Spinal cord injury (SCI) is damage to any part of the spinal cord resulting in paralysis, bowel and/or bladder incontinence, and loss of sensation and other bodily functions. Current treatments for chronic SCI are focused on managing symptoms and preventing further damage to the spinal cord with limited neuro-restorative interventions. Recent research and independent clinical trials of spinal cord stimulation (SCS) or intensive neuro-rehabilitation including neuro-robotics in participants with SCI have suggested potential malleability of the neuronal networks for neurological recovery. We hypothesize that epidural electrical stimulation (EES) delivered via SCS in conjunction with mental imagery practice and robotic neuro-rehabilitation can synergistically improve volitional motor function below the level of injury in participants with chronic clinically motor-complete SCI. In our pilot clinical RESTORES trial (RESToration Of Rehabilitative function with Epidural spinal Stimulation), we investigate the feasibility of this combined multi-modal approach in restoring volitional motor control and achieving independent overground locomotion in participants with chronic motor complete thoracic SCI. Secondary aims are to assess the safety of this combination therapy including the off-label SCS usage as well as improving functional outcome measures. To our knowledge, this is the first clinical trial that investigates the combined impact of this multi-modal EES and rehabilitation strategy in participants with chronic motor complete SCI. Two participants with chronic motor-complete thoracic SCI were recruited for this pilot trial. Both participants have successfully regained volitional motor control below their level of SCI injury and achieved independent overground walking within a month of post-operative stimulation and rehabilitation. There were no adverse events noted in our trial and there was an improvement in post-operative truncal stability score. Results from this pilot study demonstrates the feasibility of combining EES, mental imagery practice and robotic rehabilitation in improving volitional motor control below level of SCI injury and restoring independent overground walking for participants with chronic motor-complete SCI. Our team believes that this provides very exciting promise in a field currently devoid of disease-modifying therapies.
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Affiliation(s)
- Kai Rui Wan
- Department of Neurosurgery, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
- Department of Neurosurgery, National Neuroscience Institute, Singapore General Hospital, Singapore
| | - Zhi Yan Valerie Ng
- Department of Rehabilitation Medicine, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Seng Kwee Wee
- Department of Rehabilitation Medicine, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
- Singapore Institute of Technology, Singapore
| | - Misbaah Fatimah
- Department of Neurosurgery, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
- Department of Neurosurgery, National Neuroscience Institute, Singapore General Hospital, Singapore
| | - Wenli Lui
- Department of Rehabilitation Medicine, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Min Wee Phua
- Department of Rehabilitation Medicine, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Qi Yue Rosa So
- Institute for Infocomm Research, Agency for Science, Technology and Research, Singapore
| | - Tomasz Karol Maszczyk
- Institute of High Performance Computing, Agency for Science, Technology and Research, Singapore
| | - Brian Premchand
- Institute for Infocomm Research, Agency for Science, Technology and Research, Singapore
| | - Seyed Ehsan Saffari
- Center for Quantitative Medicine, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Rui Xin Justin Ker
- Department of Neurosurgery, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
- Department of Neurosurgery, National Neuroscience Institute, Singapore General Hospital, Singapore
| | - Wai Hoe Ng
- Department of Neurosurgery, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
- Department of Neurosurgery, National Neuroscience Institute, Singapore General Hospital, Singapore
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Anderson KD, Bryden AM, Gran B, Hinze SW, Richmond MA. Definitions of recovery and reintegration across the first year: A qualitative study of perspectives of persons with spinal cord injury and caregivers. Spinal Cord 2024; 62:156-163. [PMID: 38351327 PMCID: PMC11003865 DOI: 10.1038/s41393-024-00962-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 04/11/2024]
Abstract
STUDY DESIGN Longitudinal, qualitative cohort study. OBJECTIVES To understand how people with newly acquired spinal cord injury (PWS) and their support person (SP) define recovery and successful community reintegration (CR) across the first 12 months post-injury (mpi) and their satisfaction with the rate of recovery and reintegration experienced. SETTING Academic and Veterans hospitals in Midwest USA. METHODS In-depth, semi-structured interviews were conducted in two cohorts of PWS and SP during the initial inpatient rehabilitation stay, at 6 mpi, and at 12 mpi. Recordings were transcribed; four authors independently undertook line-by-line coding. The team discussed codes to reach consensus and synthesize into broader themes within the International Classification of Function, Disability, and Health and Transformative frameworks. RESULTS Data are reported on 23 PWS and 21 SP. PWS and SP are similar in defining recovery as gaining motor function and achieving independence. However, SP more frequently define recovery in terms of maintaining positivity and emotional recovery. At 12 mpi both groups shift to define recovery according to progress. Social roles, being active, and employment are persistent themes of how PWS and SP define successful CR. However, SP also frequently define successful CR as reestablishing identity and emotional adjustment. Veterans with SCI less frequently defined successful CR as employment. CONCLUSIONS This study is the first to reveal how PWS and SP define recovery and reintegration during the first 12 mpi. Given decreasing lengths of stay, this information can be used to tailor rehabilitation strategies during the critical first year of injury to optimize recovery.
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Affiliation(s)
- Kim D Anderson
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
- MetroHealth Center for Rehabilitation Research, MetroHealth System, Cleveland, OH, USA.
| | - Anne M Bryden
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- MetroHealth Center for Rehabilitation Research, MetroHealth System, Cleveland, OH, USA
| | - Brian Gran
- Department of Sociology, Case Western Reserve University College of Arts and Sciences, Cleveland, OH, USA
| | - Susan W Hinze
- Department of Sociology, Case Western Reserve University College of Arts and Sciences, Cleveland, OH, USA
| | - Mary Ann Richmond
- Spinal Cord Injury/Disorders Center, Veteran Affairs Northeast Ohio Healthcare System, Cleveland, OH, USA
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Bydon M, Qu W, Moinuddin FM, Hunt CL, Garlanger KL, Reeves RK, Windebank AJ, Zhao KD, Jarrah R, Trammell BC, El Sammak S, Michalopoulos GD, Katsos K, Graepel SP, Seidel-Miller KL, Beck LA, Laughlin RS, Dietz AB. Intrathecal delivery of adipose-derived mesenchymal stem cells in traumatic spinal cord injury: Phase I trial. Nat Commun 2024; 15:2201. [PMID: 38561341 PMCID: PMC10984970 DOI: 10.1038/s41467-024-46259-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 02/21/2024] [Indexed: 04/04/2024] Open
Abstract
Intrathecal delivery of autologous culture-expanded adipose tissue-derived mesenchymal stem cells (AD-MSC) could be utilized to treat traumatic spinal cord injury (SCI). This Phase I trial (ClinicalTrials.gov: NCT03308565) included 10 patients with American Spinal Injury Association Impairment Scale (AIS) grade A or B at the time of injury. The study's primary outcome was the safety profile, as captured by the nature and frequency of adverse events. Secondary outcomes included changes in sensory and motor scores, imaging, cerebrospinal fluid markers, and somatosensory evoked potentials. The manufacturing and delivery of the regimen were successful for all patients. The most commonly reported adverse events were headache and musculoskeletal pain, observed in 8 patients. No serious AEs were observed. At final follow-up, seven patients demonstrated improvement in AIS grade from the time of injection. In conclusion, the study met the primary endpoint, demonstrating that AD-MSC harvesting and administration were well-tolerated in patients with traumatic SCI.
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Affiliation(s)
- Mohamad Bydon
- Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA.
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Wenchun Qu
- Physical Medicine and Rehabilitation, Mayo Clinic, Jacksonville, FL, USA
| | - F M Moinuddin
- Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Ronald K Reeves
- Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | | | - Kristin D Zhao
- Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Ryan Jarrah
- Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Brandon C Trammell
- Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sally El Sammak
- Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Giorgos D Michalopoulos
- Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Konstantinos Katsos
- Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Lisa A Beck
- Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | | | - Allan B Dietz
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Elliott CS, Seufert C, Zlatev D, Kreydin E, Crew J, Shem K. Do improvements in upper extremity motor function affect changes in bladder management after cervical spinal cord injury? J Spinal Cord Med 2024; 47:239-245. [PMID: 34792429 PMCID: PMC10885770 DOI: 10.1080/10790268.2021.1999715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION One of the most important predictors of clean intermittent catheterization (CIC) adoption after spinal cord injury (SCI) is upper extremity (UE) motor function at discharge from rehabilitation. It is not clear however if post-discharge improvements in UE motor function affect future bladder management decisions. METHODS We assessed persons with cervical SCI in the National Spinal Cord Injury Dataset for the years 2000-2016 who underwent motor examination at discharge from rehabilitation and again at 1-year follow-up. Individuals were stratified based on a previously described algorithm which categorizes the ability to independently perform CIC based upon UE motor scores. Improvements in the predicted ability to self-catheterize over the first year after rehabilitation discharge were evaluated in relation to bladder management. RESULTS Despite 15% of our SCI cohort improving from "less than able to independently catheterize" to "able to independently catheterize", more patients in the overall cohort dropped out of CIC (175/643 = 27.2%) than adopted CIC (68/548 = 12.4%) (P < .001). We found that in those initially categorized as "less than able to independently catheterize" at the time of rehabilitation discharge, CIC adoption was not significantly different at 1-year follow-up whether or not there was motor improvement to "able to independently catheterize" (12.7% vs 9.2% respectively, P = 0.665). Between these two groups, CIC dropout was also equivalent (34.3% vs 30.0% respectively, P = 0.559). CONCLUSIONS In the first year after rehabilitation, more overall SCI patients transition away from CIC than convert to CIC. Significant improvements in UE motor function during the first year after rehabilitation discharge do not appear to affect bladder management decisions.
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Affiliation(s)
- Christopher S. Elliott
- Division of Urology, Santa Clara Valley Medical Center, San Jose, California, USA
- Department of Urology, Stanford University Medical Center, Stanford, California, USA
| | - Caleb Seufert
- Department of Urology, Stanford University Medical Center, Stanford, California, USA
| | - Dimitar Zlatev
- Department of Urology, Stanford University Medical Center, Stanford, California, USA
| | - Evgeniy Kreydin
- Department of Urology, University of Southern California, Los Angeles, California, USA
| | - James Crew
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Kazuko Shem
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, California, USA
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Mukhametova E, Militskova A, Biktimirov A, Kharin N, Semenova E, Sachenkov O, Baltina T, Lavrov I. Consecutive Transcutaneous and Epidural Spinal Cord Neuromodulation to Modify Clinical Complete Paralysis-the Proof of Concept. Mayo Clin Proc Innov Qual Outcomes 2024; 8:1-16. [PMID: 38186923 PMCID: PMC10770429 DOI: 10.1016/j.mayocpiqo.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Objective To evaluate the effect of transcutaneous (tSCS) and epidural electrical spinal cord stimulation (EES) in facilitating volitional movements, balance, and nonmotor functions, in this observational study, tSCS and EES were consecutively tested in 2 participants with motor complete spinal cord injury (SCI). Participants and Methods Two participants (a 48-year-old woman and a 28-year-old man), both classified as motor complete spinal injury, were enrolled in the study. Both participants went through a unified protocol, such as an initial electrophysiological assessment of neural connectivity, consecutive tSCS and EES combined with 8 wks of motor training with electromyography (EMG) and kinematic evaluation. The study was conducted from May 1, 2019, to December 31, 2021. Results In both participants, tSCS reported a minimal improvement in voluntary movements still essential to start tSCS-enabled rehabilitation. Compared with tSCS, following EES showed immediate improvement in voluntary movements, whereas tSCS was more effective in improving balance and posture. Continuous improvement in nonmotor functions was found during tSCS-enabled and then during EES-enabled motor training. Conclusion Results report a significant difference in the effect of tSCS and EES on the recovery of neurologic functions and support consecutive tSCS and EES applications as a potential therapy for SCI. The proposed approach may help in selecting patients with SCI responsive to neuromodulation. It would also help initiate neuromodulation and rehabilitation therapy early, particularly for motor complete SCI with minimal effect from conventional rehabilitation.
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Affiliation(s)
- Elvira Mukhametova
- Department of Neurology, Department of Biomedical Engineering, Mayo Clinic, Rochester, MN
- Laboratory of Neuromodulation, Kazan Federal University, Institute of Fundamental Medicine and Biology, Kazan, Russia
- Laboratory of Movement Physiology, Federal State Institution of Science Institute of Physiology, IP Pavlov, Russian Academy of Sciences, Saint Petersburg, Russia
| | - Alena Militskova
- Department of Neurology, Department of Biomedical Engineering, Mayo Clinic, Rochester, MN
- Laboratory of Neuromodulation, Kazan Federal University, Institute of Fundamental Medicine and Biology, Kazan, Russia
- Laboratory of Movement Physiology, Federal State Institution of Science Institute of Physiology, IP Pavlov, Russian Academy of Sciences, Saint Petersburg, Russia
| | - Artur Biktimirov
- Center of Neurotechnologies, Virtual, and Augmented Reality Technologies, Department of Neurosurgery, Far Eastern Federal University, Russia
| | - Nikita Kharin
- Laboratory of Shell Mechanics, N.I. Lobachevsky Institute of Mathematics and Mechanics, Kazan Federal University, Kazan, Russia
| | - Elena Semenova
- Laboratory of Shell Mechanics, N.I. Lobachevsky Institute of Mathematics and Mechanics, Kazan Federal University, Kazan, Russia
| | - Oskar Sachenkov
- Laboratory of Shell Mechanics, N.I. Lobachevsky Institute of Mathematics and Mechanics, Kazan Federal University, Kazan, Russia
| | - Tatiana Baltina
- Laboratory of Neuromodulation, Kazan Federal University, Institute of Fundamental Medicine and Biology, Kazan, Russia
| | - Igor Lavrov
- Department of Neurology, Department of Biomedical Engineering, Mayo Clinic, Rochester, MN
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Alavinia M, Farahani F, Musselman K, Plourde K, Omidvar M, Verrier MC, Aliabadi S, Craven BC. Convergent validity and responsiveness of The Standing and Walking Assessment Tool (SWAT) among individuals with non-traumatic spinal cord injury. Front Neurol 2024; 14:1280225. [PMID: 38322795 PMCID: PMC10844483 DOI: 10.3389/fneur.2023.1280225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/28/2023] [Indexed: 02/08/2024] Open
Abstract
Aim This study aimed to (1) describe the use of the Standing and Walking Assessment Tool (SWAT) among individuals with non-traumatic spinal cord injury or disease (NT-SCI/D); (2) evaluate the convergent validity of SWAT for use among inpatients with NT-SCI/D; (3) describe SWAT responsiveness; and (4) explore the relationship between hours of walking therapy and SWAT change. Methods A quality improvement project was conducted at the University Health Network between 2019 and 2022. Participants' demographics and impairments data, rehabilitation length of stay, and FIM scores were obtained from the National Rehabilitation Reporting System. The walking measure data were collected by therapists as part of routine practice. Hours of part- or whole-gait practice were abstracted from medical records. To determine convergent validity, Spearman's correlation coefficients were calculated between SWAT stages (admission and discharge) and the walking measures. The change in SWAT levels was calculated to determine responsiveness. Spearman's correlation coefficient was calculated between SWAT change and hours of walking therapy. Results Among adult NT-SCI/D participants with potential walking capacity (SWAT≥1B), the majority were classified as American Spinal Injury Association (ASIA) Impairment Scale D (AIS D) at admission. The SWAT category of 1C (N = 100, 18%) was the most frequent at admission. The most frequent SWAT stage at discharge was 3C among participants with NT-SCI/D, with positive conversions in SWAT stages from admission to discharge (N = 276, 33%). The mean change in SWAT score was 3 for participants with T-SCI and NT-SCI/D. Moderate correlations between SWAT stages and walking measures were observed. The correlation of hours of gait therapy with the SWAT change (admission to discharge) was 0.44 (p < 0001). Conclusion The SWAT has sufficient convergent validity and responsiveness for describing standing and walking recovery and communicating/monitoring rehabilitation progress among patients with NT-SCI/D.
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Affiliation(s)
- Mohammad Alavinia
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Farnoosh Farahani
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Kristin Musselman
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kristina Plourde
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Maryam Omidvar
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Molly C. Verrier
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Saina Aliabadi
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- School of Graduate Studies, University of Toronto, Toronto, ON, Canada
| | - B. Catharine Craven
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Bak AB, Moghaddamjou A, Harrop JS, Aarabi B, Fehlings MG. The Impact of Interhospital Transfer on the Extent of Neurological Recovery in Acute Traumatic Spinal Cord Injury: Analysis of a Prospective Multicenter Data Set in 970 Cases. Neurosurgery 2024; 94:90-98. [PMID: 37607093 DOI: 10.1227/neu.0000000000002642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/21/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Interhospital transfer from community hospitals to centers specialized in managing traumatically injured individuals can strain patients, healthcare systems, and delay appropriate care. The purpose was to compare long-term neurological outcomes in transferred or directly admitted patients with traumatic spinal cord injury (SCI). METHODS An ambispective cohort study was conducted using prospectively collected data (between 2005 and 2018) from 11 specialized level 1 trauma centers across the United States and Canada. All patients who underwent surgical management for SCI were included and placed into 2 comparison cohorts: (1) direct admission and (2) transfer from intermediate hospital. Outcomes were change in American Spinal Injury Association Impairment Scale grade and its components: upper-extremity motor, lower-extremity motor, pinprick, and light touch scores from baseline (assessed ≤72 hours after injury) to follow-up (12-52 weeks). Nearest-neighbor 1:1 propensity score matching between the transferred and directly admitted cohorts was performed. Paired analysis using McNemar's test and paired Student's t -test was used to determine the extent of the difference in neurological outcomes. RESULTS Nine hundred seventy patients (55.5% male, 55.2 ± 18.9 years) with traumatic SCI were directly admitted to a specialized trauma center (N = 474, 48.9%) or transferred from an intermediate hospital (N = 496, 51.1%). After propensity score matching, 283 pairs were matched. Compared with a matched cohort of transferred patients, American Spinal Injury Association Impairment Scale grade improved more in directly admitted patients (56.2% vs 46.3%, P = .024), as did upper-extremity motor score (13.7 ± 12.8 vs 10.4 ± 11.5, P = .018) and light touch score (22.0 ± 29.7 vs 16.9 ± 26.6, P = .034). CONCLUSION Patients with SCI directly admitted to specialized trauma centers have greater neurological recovery compared with patients transferred from an intermediate hospital. Feasibility of direct admission to a center specialized in the management of acute SCI through implementation of a standardized code program must be further investigated. LEVEL OF EVIDENCE Therapeutic level II.
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Affiliation(s)
- Alex B Bak
- Temerty Faculty of Medicine, University of Toronto, Toronto , Ontario , Canada
| | - Ali Moghaddamjou
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto , Ontario , Canada
- Krembil Neuroscience Centre, University Health Network, Toronto , Ontario , Canada
| | - James S Harrop
- Department of Neurosurgical and Orthopedic Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia , Pennsylvania , USA
| | - Bizhan Aarabi
- Department of Neurosurgery, Division of Biostatistics and Bioinformatics, University of Maryland School of Medicine, Baltimore , Maryland , USA
| | - Michael G Fehlings
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto , Ontario , Canada
- Krembil Neuroscience Centre, University Health Network, Toronto , Ontario , Canada
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11
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Morrison D, Pinpin C, Lee A, Sison C, Chory A, Gregersen PK, Forrest G, Kirshblum S, Harkema SJ, Boakye M, Harrop JS, Bryce TN, Schwab JM, Kwon BK, Stein AB, Bank MA, Bloom O. Profiling Immunological Phenotypes in Individuals During the First Year After Traumatic Spinal Cord Injury: A Longitudinal Analysis. J Neurotrauma 2023; 40:2621-2637. [PMID: 37221869 PMCID: PMC10722895 DOI: 10.1089/neu.2022.0500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Abstract Individuals with SCI are severely affected by immune system changes, resulting in increased risk of infections and persistent systemic inflammation. While recent data support that immunological changes after SCI differ in the acute and chronic phases of living with SCI, only limited immunological phenotyping in humans is available. To characterize dynamic molecular and cellular immune phenotypes over the first year, we assess RNA (bulk-RNA sequencing), protein, and flow cytometry (FACS) profiles of blood samples from 12 individuals with SCI at 0-3 days and at 3, 6, and 12 months post injury (MPI) compared to 23 uninjured individuals (controls). We identified 967 differentially expressed (DE) genes in individuals with SCI (FDR <0.001) compared to controls. Within the first 6 MPI we detected a reduced expression of NK cell genes, consistent with reduced frequencies of CD56bright, CD56dim NK cells present at 12 MPI. Over 6MPI, we observed increased and prolonged expression of genes associated with inflammation (e.g. HMGB1, Toll-like receptor signaling) and expanded frequencies of monocytes acutely. Canonical T-cell related DE genes (e.g. FOXP3, TCF7, CD4) were upregulated during the first 6 MPI and increased frequencies of activated T cells at 3-12 MPI. Neurological injury severity was reflected in distinct whole blood gene expression profiles at any time after SCI, verifying a persistent 'neurogenic' imprint. Overall, 2876 DE genes emerge when comparing motor complete to motor incomplete SCI (ANOVA, FDR <0.05), including those related to neutrophils, inflammation, and infection. In summary, we identify a dynamic immunological phenotype in humans, including molecular and cellular changes which may provide potential targets to reduce inflammation, improve immunity, or serve as candidate biomarkers of injury severity.
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Affiliation(s)
- Debra Morrison
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Camille Pinpin
- Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, New York, USA
| | - Annette Lee
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
- Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, New York, USA
| | - Cristina Sison
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
- Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, New York, USA
| | - Ashley Chory
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Peter K. Gregersen
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
- Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, New York, USA
| | - Gail Forrest
- Tim and Caroline Reynolds Center for Spinal Stimulation, Center for Mobility and Human Engineering Research, West Orange, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Steven Kirshblum
- Tim and Caroline Reynolds Center for Spinal Stimulation, Center for Mobility and Human Engineering Research, West Orange, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Kessler Institute for Rehabilitation. West Orange, New Jersey, USA
| | - Susan J. Harkema
- Kentucky Spinal Injury Research Center, School of Medicine, University of Louisville, Louisville, Kentucky, USA
- Department of Neurosurgery, School of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Maxwell Boakye
- Kentucky Spinal Injury Research Center, School of Medicine, University of Louisville, Louisville, Kentucky, USA
- Department of Neurosurgery, School of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - James S. Harrop
- Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Thomas N. Bryce
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Jan M. Schwab
- The Belford Center for Spinal Cord Injury, Spinal Cord Division, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
- Department of Neurology, Spinal Cord Division, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Brian K. Kwon
- International Collaboration on Repair Discoveries (ICORD), Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam B. Stein
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
- Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, New York, USA
| | - Matthew A. Bank
- Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, New York, USA
- North Shore University Hospital, Manhasset, New York, USA
| | - Ona Bloom
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
- Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, New York, USA
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12
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Angeli C, Wagers S, Harkema S, Rejc E. Sensory Information Modulates Voluntary Movement in an Individual with a Clinically Motor- and Sensory-Complete Spinal Cord Injury: A Case Report. J Clin Med 2023; 12:6875. [PMID: 37959340 PMCID: PMC10647542 DOI: 10.3390/jcm12216875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
Motor recovery following a complete spinal cord injury is not likely. This is partially due to insurance limitations. Rehabilitation strategies for individuals with this type of severe injury focus on the compensation for the activities of daily living in the home and community and not on the restoration of function. With limited time in therapies, the initial goals must focus on getting the patient home safely without the expectation of recovery of voluntary movement below the level of injury. In this study, we report a case of an individual with a chronic, cervical (C3)-level clinically motor- and sensory-complete injury who was able to perform voluntary movements with both upper and lower extremities when positioned in a sensory-rich environment conducive to the specific motor task. We show how he is able to intentionally perform push-ups, trunk extensions and leg presses only when appropriate sensory information is available to the spinal circuitry. These data show that the human spinal circuitry, even in the absence of clinically detectable supraspinal input, can generate motor patterns effective for the execution of various upper and lower extremity tasks, only when appropriate sensory information is present. Neurorehabilitation in the right sensory-motor environment that can promote partial recovery of voluntary movements below the level of injury, even in individuals diagnosed with a clinically motor-complete spinal cord injury.
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Affiliation(s)
- Claudia Angeli
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ 07052, USA;
- Department of Bioengineering, University of Louisville, Louisville, KY 40292, USA
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA; (S.W.); (S.H.)
| | - Sarah Wagers
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA; (S.W.); (S.H.)
- Division of Physical Medicine and Rehabilitation, University of Louisville, Louisville, KY 40292, USA
| | - Susan Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA; (S.W.); (S.H.)
| | - Enrico Rejc
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ 07052, USA;
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA; (S.W.); (S.H.)
- Department of Medicine, University of Udine, 33100 Udine, Italy
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13
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Hirota R, Sasaki M, Honmou O, Yamashita T. Mesenchymal Stem Cell Transplantation for Spinal Cord Injury: Current Status and Prospects. Spine Surg Relat Res 2023; 7:319-326. [PMID: 37636138 PMCID: PMC10447197 DOI: 10.22603/ssrr.2022-0234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 12/21/2022] [Indexed: 02/21/2023] Open
Abstract
Since the 1990s, our group has been conducting basic research on regenerative medicine using various cell types to treat several central nervous system diseases, including spinal cord injury (SCI). We have reported many positive effects of the intravenous administration of mesenchymal stem cells (MSCs) derived from the bone marrow. In the current study, MSCs were administered intravenously to a rat model of severe SCI (crush injury) during the acute to subacute stages-considerable motor function recovery was observed. Furthermore, MSC transplantation in a chronic-phase SCI model improved motor function. In this review, we discuss recent updates in basic research on the intravenous infusion of MSCs and prospects for SCI research.
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Affiliation(s)
- Ryosuke Hirota
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masanori Sasaki
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Osamu Honmou
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
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14
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Singh RE, Ahmadi A, Parr AM, Samadani U, Krassioukov AV, Netoff TI, Darrow DP. Epidural stimulation restores muscle synergies by modulating neural drives in participants with sensorimotor complete spinal cord injuries. J Neuroeng Rehabil 2023; 20:59. [PMID: 37138361 PMCID: PMC10155428 DOI: 10.1186/s12984-023-01164-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 03/30/2023] [Indexed: 05/05/2023] Open
Abstract
Multiple studies have corroborated the restoration of volitional motor control after motor-complete spinal cord injury (SCI) through the use of epidural spinal cord stimulation (eSCS), but rigorous quantitative descriptions of muscle coordination have been lacking. Six participants with chronic, motor and sensory complete SCI underwent a brain motor control assessment (BMCA) consisting of a set of structured motor tasks with and without eSCS. We investigated how muscle activity complexity and muscle synergies changed with and without stimulation. We performed this analysis to better characterize the impact of stimulation on neuromuscular control. We also recorded data from nine healthy participants as controls. Competition exists between the task origin and neural origin hypotheses underlying muscle synergies. The ability to restore motor control with eSCS in participants with motor and sensory complete SCI allows us to test whether changes in muscle synergies reflect a neural basis in the same task. Muscle activity complexity was computed with Higuchi Fractal Dimensional (HFD) analysis, and muscle synergies were estimated using non-negative matrix factorization (NNMF) in six participants with American Spinal Injury Association (ASIA) Impairment Score (AIS) A. We found that the complexity of muscle activity was immediately reduced by eSCS in the SCI participants. We also found that over the follow-up sessions, the muscle synergy structure of the SCI participants became more defined, and the number of synergies decreased over time, indicating improved coordination between muscle groups. Lastly, we found that the muscle synergies were restored with eSCS, supporting the neural hypothesis of muscle synergies. We conclude that eSCS restores muscle movements and muscle synergies that are distinct from those of healthy, able-bodied controls.
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Affiliation(s)
- Rajat Emanuel Singh
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
- Department of Kinesiology, Northwestern College, Orange, IA, USA
| | - Aliya Ahmadi
- Division of Neurosurgery, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Ann M Parr
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Uzma Samadani
- Department of Bioinformatics & Computational Biology, UMN, Minneapolis, MN, USA
- Minneapolis Veteran Affairs Medical Center, Minneapolis, MN, USA
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia (UBC), Vancouver, Canada
- Division of Physical Medicine & Rehabilitation, Department of Medicine, UBC, British Columbia , BC, Canada
- GF Strong Rehabilitation Center, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Theoden I Netoff
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - David P Darrow
- Division of Neurosurgery, Hennepin County Medical Center, Minneapolis, MN, USA.
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA.
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15
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Rose Hill EJ, Bertelli JA. Spinal Cord Injury: Epidemiology, Spontaneous Recovery, and Hand Therapy for the Reconstructive Hand Surgeon. J Hand Surg Am 2023:S0363-5023(23)00031-X. [PMID: 36963997 DOI: 10.1016/j.jhsa.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 10/13/2022] [Accepted: 01/08/2023] [Indexed: 03/26/2023]
Abstract
People with spinal cord injury (SCI) prioritize hand function above all else as a reconstructive goal, yet remain a markedly undertreated population by hand surgeons. This review article provides an overview of the epidemiology of SCI and the unmet clinical need of these patients. Further, this article outlines the natural history of SCI, including the expected spontaneous recovery over time and the expectations of hand function when treated with hand therapy alone. This review aims to equip reconstructive hand surgeons with a sound understanding of the basic principles of SCI and recovery and provide a rationale for when to intervene with surgery. In the last decade, this field has changed dramatically with the advent of reliable nerve transfers, making referral and surgical intervention time-sensitive. Therefore this review aims to highlight the expectations from hand therapy alone in this group, the urgent need for early referral to allow nerve transfer options to be viable, and the strategies for overcoming the barriers to these referrals. This offers the opportunity for surgeons to expand their tetraplegia practices while maximizing the considerable contributions to the hand function and quality of life of these patients.
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Affiliation(s)
- Elspeth Jane Rose Hill
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT.
| | - Jayme Augusto Bertelli
- Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina, Brazil; Center of Biological and Health Sciences, Department of Neurosurgery, University of the South of Santa Catarina (Unisul), Tubarão, Brazil; Department of Plastic Surgery, Joana de Gusmão Children's Hospital, Florianópolis, Santa Catarina, Brazil
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16
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Wang J, Xu L, Peng D, Zhu Y, Gu Z, Yao Y, Li H, Cao X, Fu CY, Zheng M, Song X, Ding Y, Shen Y, Zhong J, Chen YY, Hu J, Wang LL. IFN-γ-STAT1-mediated CD8 + T-cell-neural stem cell cross talk controls astrogliogenesis after spinal cord injury. Inflamm Regen 2023; 43:12. [PMID: 36782279 PMCID: PMC9926765 DOI: 10.1186/s41232-023-00263-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/31/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Spinal cord injury (SCI) causes nearly all patients to suffer from protracted disabilities. An emerging therapeutic strategy involving the recruitment of endogenous neural stem cells (NSCs) has been developed. However, endogenous NSCs in the adult spinal cord differentiate into mostly astrocytes after traumatic injury, forming glial scars, which is a major cause of regeneration failure in SCI. Thus, understanding which factors drive the activation and differentiation of endogenous NSCs after SCI is critical for developing therapeutic drugs. METHODS The infiltration, state, and location of CD8+ T cells in spinal cord after traumatic injury were analyzed by flow cytometry and immunofluorescence (IF) staining. The Basso Mouse Scale (BMS) scores and rotarod testing were used for motor behavioral analysis. NSCs were co-cultured with CD8+ T cells. EdU assay was used to detect proliferative cells. Western blotting was used to analyze the expression levels of STAT1, p-STAT1, and p27. ChIP-seq and ChIP-qRT-PCR analyses were used to detect the downstream of STAT1. Nestin-CreERT2::Ai9 transgenic mice were used to genetic lineage tracing of Nestin+ NSCs after SCI in vivo. RESULTS A prolonged increase of activated CD8+ T cells occurs in the injured spinal cords. The behavioral analysis demonstrated that the administration of an anti-CD8 antibody promotes the recovery of locomotor function. Then, we discovered that CD8+ T cells suppressed the proliferation of NSCs and promoted the differentiation of NSCs into astrocytes by the IFN-γ-STAT1 pathway in vitro. ChIP-seq and ChIP-qRT-PCR analysis revealed that STAT1 could directly bind to the promoters of astrocyte marker genes GFAP and Aldh1l1. Genetic lineage tracing of Nestin+ NSCs demonstrated that most NSCs differentiated into astrocytes following SCI. Depleting CD8+ T cells reduced the differentiation of NSCs into astrocytes and instead promoted the differentiation of NSCs into oligodendrocytes. CONCLUSION In conclusion, CD8+ T cells suppressed the proliferation of NSCs and promoted the differentiation of NSCs into astrocytes by the IFN-γ-STAT1-GFAP/Aldhl1l axis. Our study identifies INF-γ as a critical mediator of CD8+ T-cell-NSC cross talk and a potential node for therapeutic intervention in SCI.
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Affiliation(s)
- Jingyu Wang
- grid.412465.0Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Key Laboratory of Precise Treatment and Clinical Translational Research of Neurological Diseases, Hangzhou, 310009 China
| | - Lintao Xu
- grid.412465.0Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Key Laboratory of Precise Treatment and Clinical Translational Research of Neurological Diseases, Hangzhou, 310009 China
| | - Deqing Peng
- grid.417401.70000 0004 1798 6507Department of Neurosurgery, Center for Rehabilitation Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital Hangzhou Medical College), Hangzhou, Zhejiang China
| | - Yongjian Zhu
- grid.412465.0Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Key Laboratory of Precise Treatment and Clinical Translational Research of Neurological Diseases, Hangzhou, 310009 China
| | - Zhaowen Gu
- grid.412465.0Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Key Laboratory of Precise Treatment and Clinical Translational Research of Neurological Diseases, Hangzhou, 310009 China
| | - Ying Yao
- grid.412465.0Department of Neurointensive Care Unit, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009 China
| | - Heyangzi Li
- grid.13402.340000 0004 1759 700XDepartment of Basic Medicine Sciences, Zhejiang University School of Medicine, Hangzhou, 310058 China
| | - Xi Cao
- grid.13402.340000 0004 1759 700XDepartment of Basic Medicine Sciences, Zhejiang University School of Medicine, Hangzhou, 310058 China
| | - Chun-yan Fu
- grid.13402.340000 0004 1759 700XDepartment of Basic Medicine Sciences, Zhejiang University School of Medicine, Hangzhou, 310058 China
| | - Mingzhi Zheng
- grid.506977.a0000 0004 1757 7957School of Basic Medical Sciences & Forensic Medicine of Hangzhou Medical College, Hangzhou, 310053 China
| | - Xinghui Song
- grid.13402.340000 0004 1759 700XCentral Laboratory, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006 China
| | - Yueming Ding
- grid.13402.340000 0004 1759 700XSchool of Medicine, Zhejiang University City College, Hangzhou, 310015 China
| | - Yueliang Shen
- grid.13402.340000 0004 1759 700XDepartment of Basic Medicine Sciences, Zhejiang University School of Medicine, Hangzhou, 310058 China
| | - Jinjie Zhong
- grid.13402.340000 0004 1759 700XDepartment of Basic Medicine Sciences and Department of Obstetrics of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058 China
| | - Ying-ying Chen
- grid.13402.340000 0004 1759 700XDepartment of Basic Medicine Sciences and Department of Obstetrics of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058 China
| | - Jue Hu
- School of Basic Medical Sciences & Forensic Medicine of Hangzhou Medical College, Hangzhou, 310053, China.
| | - Lin-lin Wang
- grid.13402.340000 0004 1759 700XDepartment of Basic Medicine Sciences and Department of Orthopaedics of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310058 China
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17
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Segmental motor recovery after cervical spinal cord injury relates to density and integrity of corticospinal tract projections. Nat Commun 2023; 14:723. [PMID: 36759606 PMCID: PMC9911610 DOI: 10.1038/s41467-023-36390-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023] Open
Abstract
Cervical spinal cord injury (SCI) causes extensive impairments for individuals which may include dextrous hand function. Although prior work has focused on the recovery at the person-level, the factors determining the recovery of individual muscles are poorly understood. Here, we investigate the muscle-specific recovery after cervical spinal cord injury in a retrospective analysis of 748 individuals from the European Multicenter Study about Spinal Cord Injury (NCT01571531). We show associations between corticospinal tract (CST) sparing and upper extremity recovery in SCI, which improves the prediction of hand muscle strength recovery. Our findings suggest that assessment strategies for muscle-specific motor recovery in acute spinal cord injury are improved by accounting for CST sparing, and complement person-level predictions.
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18
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Schading S, David G, Max Emmenegger T, Achim C, Thompson A, Weiskopf N, Curt A, Freund P. Dynamics of progressive degeneration of major spinal pathways following spinal cord injury: A longitudinal study. Neuroimage Clin 2023; 37:103339. [PMID: 36758456 PMCID: PMC9939725 DOI: 10.1016/j.nicl.2023.103339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/23/2022] [Accepted: 01/26/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Following spinal cord injury (SCI), disease processes spread gradually along the spinal cord forming a spatial gradient with most pronounced changes located at the lesion site. However, the dynamics of this gradient in SCI patients is not established. OBJECTIVE This study tracks the spatiotemporal dynamics of remote anterograde and retrograde spinal tract degeneration in the upper cervical cord following SCI over two years utilizing quantitative MRI. METHODS Twenty-three acute SCI patients (11 paraplegics, 12 tetraplegics) and 21 healthy controls were scanned with a T1-weighted sequence for volumetry and a FLASH sequence for myelin-sensitive magnetization transfer saturation (MTsat) of the upper cervical cord. We estimated myelin content from MTsat maps within the corticospinal tracts (CST) and dorsal columns (DC) and measured spinal cord atrophy by means of left-right width (LRW) and anterior-posterior width (APW) on the T1-weighted images across cervical levels C1-C3. MTsat in the CST and LRW were considered proxies for retrograde degeneration, while MTsat in the DC and APW provided evidence for anterograde degeneration, respectively. Using regression models, we compared the temporal and spatial trajectories of these MRI readouts between tetraplegics, paraplegics, and controls over a 2-year period and assessed their associations with clinical improvement. RESULTS Linear rates and absolute differences in myelin-sensitive MTsat indicated retrograde and anterograde neurodegeneration in the CST and DC, respectively. Changes in MTsat within the CST and in LRW progressively developed over time forming a gradient towards lower cervical levels by 2 years after injury, especially in tetraplegics (change per cervical level in MTsat: -0.247 p.u./level, p = 0.034; in LRW: -0.323 mm/level, p = 0.024). MTsat within the DC was already decreased at cervical levels C1-C3 at baseline (1.5 months after injury) in both tetra- and paraplegics, while linear decreases in APW over time were similar across C1-C3, preserving the spatial gradient. The relative improvement in light touch score was associated with MTsat within the DC at baseline (rs = 0.575, p = 0.014). CONCLUSION Rostral and remote to the injury, the CST and DC show ongoing structural changes, indicative of myelin reductions and atrophy within 2 years after SCI. While anterograde degeneration in the DC was already detectable uniformly at C1-C3 early following SCI, retrograde degeneration in the CST developed over time revealing specific spatial and temporal neurodegenerative gradients. Disentangling and quantifying such dynamic pathological processes may provide biomarkers for regenerative and remyelinating therapies along entire spinal pathways.
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Affiliation(s)
- Simon Schading
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Gergely David
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Tim Max Emmenegger
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Cristian Achim
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Alan Thompson
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Nikolaus Weiskopf
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Felix Bloch Institute for Solid State Physics, Faculty of Physics and Earth Sciences, Leipzig University, Leipzig, Germany
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Patrick Freund
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Wellcome Trust Centre for Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, UK.
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19
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Hirota R, Sasaki M, Kataoka-Sasaki Y, Oshigiri T, Kurihara K, Fukushi R, Oka S, Ukai R, Yoshimoto M, Kocsis JD, Yamashita T, Honmou O. Enhanced Network in Corticospinal Tracts after Infused Mesenchymal Stem Cells in Spinal Cord Injury. J Neurotrauma 2022; 39:1665-1677. [PMID: 35611987 PMCID: PMC9734021 DOI: 10.1089/neu.2022.0106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Although limited spontaneous recovery occurs after spinal cord injury (SCI), current knowledge reveals that multiple forms of axon growth in spared axons can lead to circuit reorganization and a detour or relay pathways. This hypothesis has been derived mainly from studies of the corticospinal tract (CST), which is the primary descending motor pathway in mammals. The major CST is the dorsal CST (dCST), being the major projection from cortex to spinal cord. Two other components often called "minor" pathways are the ventral and the dorsal lateral CSTs, which may play an important role in spontaneous recovery. Intravenous infusion of mesenchymal stem cells (MSCs) provides functional improvement after SCI with an enhancement of axonal sprouting of CSTs. Detailed morphological changes of CST pathways, however, have not been fully elucidated. The primary objective was to evaluate detailed changes in descending CST projections in SCI after MSC infusion. The MSCs were infused intravenously one day after SCI. A combination of adeno-associated viral vector (AAV), which is an anterograde and non-transsynaptic axonal tracer, was injected 14 days after SCI induction. The AAV with advanced tissue clearing techniques were used to visualize the distribution pattern and high-resolution features of the individual axons coursing from above to below the lesion. The results demonstrated increased observable axonal connections between the dCST and axons in the lateral funiculus, both rostral and caudal to the lesion core, and an increase in observable axons in the dCST below the lesion. This increased axonal network could contribute to functional recovery by providing greater input to the spinal cord below the lesion.
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Affiliation(s)
- Ryosuke Hirota
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, and Sapporo Medical University School of Medicine, Sapporo, Japan.,Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masanori Sasaki
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, and Sapporo Medical University School of Medicine, Sapporo, Japan.,Department of Neurology, and Yale University School of Medicine, New Haven, Connecticut, USA.,Address correspondence to: Masanori Sasaki, MD, PhD, Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, S1W17, Chuo-ku, Sapporo, Hokkaido 060-8556, Japan
| | - Yuko Kataoka-Sasaki
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, and Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tsutomu Oshigiri
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, and Sapporo Medical University School of Medicine, Sapporo, Japan.,Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kota Kurihara
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, and Sapporo Medical University School of Medicine, Sapporo, Japan.,Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Ryunosuke Fukushi
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, and Sapporo Medical University School of Medicine, Sapporo, Japan.,Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Shinichi Oka
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, and Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Ryo Ukai
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, and Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Mitsunori Yoshimoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Jeffery D. Kocsis
- Department of Neurology, and Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Neuroscience, Yale University School of Medicine, New Haven, Connecticut, USA.,Center for Neuroscience and Regeneration Research, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Osamu Honmou
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, and Sapporo Medical University School of Medicine, Sapporo, Japan.,Department of Neurology, and Yale University School of Medicine, New Haven, Connecticut, USA
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20
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Cui Z, Li Y, Huang S, Wu X, Fu X, Liu F, Wan X, Wang X, Zhang Y, Qiu H, Chen F, Yang P, Zhu S, Li J, Chen W. BCI system with lower-limb robot improves rehabilitation in spinal cord injury patients through short-term training: a pilot study. Cogn Neurodyn 2022; 16:1283-1301. [PMID: 36408074 PMCID: PMC9666612 DOI: 10.1007/s11571-022-09801-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/27/2021] [Accepted: 11/04/2021] [Indexed: 12/27/2022] Open
Abstract
In the recent years, the increasing applications of brain-computer interface (BCI) in rehabilitation programs have enhanced the chances of functional recovery for patients with neurological disorders. We presented and validated a BCI system with a lower-limb robot for short-term training of patients with spinal cord injury (SCI). The cores of this system included: (1) electroencephalogram (EEG) features related to motor intention reported through experiments and used to drive the robot; (2) a decision tree to determine the training mode provided for patients with different degrees of injuries. Seven SCI patients (one American Spinal Injury Association Impairment Scale (AIS) A, three AIS B, and three AIS C) participated in the short-term training with this system. All patients could learn to use the system rapidly and maintained a high intensity during the training program. The strength of the lower limb key muscles of the patients was improved. Four AIS A/B patients were elevated to AIS C. The cumulative results indicate that clinical application of the BCI system with lower-limb robot is feasible and safe, and has potentially positive effects on SCI patients. Supplementary Information The online version contains supplementary material available at 10.1007/s11571-022-09801-6.
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Affiliation(s)
- Zhengzhe Cui
- School of Mechanical Engineering, Zhejiang University, Hangzhou, China
| | - Yongqiang Li
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Sisi Huang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xixi Wu
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiangxiang Fu
- School of Mechanical Engineering, Zhejiang University, Hangzhou, China
| | - Fei Liu
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaojiao Wan
- School of Mechanical Engineering, Zhejiang University, Hangzhou, China
| | - Xue Wang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yuting Zhang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Huaide Qiu
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fang Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Peijin Yang
- School of Mechanical Engineering, Zhejiang University, Hangzhou, China
| | - Shiqiang Zhu
- School of Mechanical Engineering, Zhejiang University, Hangzhou, China
| | - Jianan Li
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Weidong Chen
- Qiushi Academy for Advanced Studies, Zhejiang University, Hangzhou, China
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21
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Sangari S, Perez MA. Prevalence of spasticity in humans with spinal cord injury with different injury severity. J Neurophysiol 2022; 128:470-479. [PMID: 35507475 PMCID: PMC9423778 DOI: 10.1152/jn.00126.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/22/2022] [Accepted: 04/22/2022] [Indexed: 11/22/2022] Open
Abstract
Spasticity is one of the most common symptoms manifested following spinal cord injury (SCI). The aim of this study was to assess spasticity in individuals with subacute and chronic SCI with different injury severity, standardizing the time and assessments of spasticity. We tested 110 individuals with SCI classified by the American Spinal Injury Association Impairment Scale (AIS) as either motor complete (AIS A and B; subacute, n = 25; chronic, n = 33) or motor incomplete (AIS C and D; subacute, n = 23; chronic, n = 29) at a similar time after injury (subacute, ∼1 mo after injury during inpatient rehabilitation and chronic, ≥1 yr after injury) using clinical (modified Ashworth scale) and kinematic (pendulum test) outcomes to assess spasticity in the quadriceps femoris muscle. Using both methodologies, we found that among individuals with subacute motor complete injuries, only a minority showed spasticity, whereas the majority exhibited no spasticity. This finding stands in contrast to individuals with subacute motor incomplete injury, where both methodologies revealed that a majority exhibited spasticity, whereas a minority exhibited no spasticity. In chronic injuries, most individuals showed spasticity regardless of injury severity. Notably, when spasticity was present, its magnitude was similar across injury severity in both subacute and chronic injuries. Our results suggest that the prevalence, not the magnitude, of spasticity differs between individuals with motor complete and incomplete SCI in the subacute and chronic stages of the injury. We thus argue that considering the "presence of spasticity" might help the stratification of participants with motor complete injuries for clinical trials.NEW & NOTEWORTHY The prevalence of spasticity in humans with SCI remains poorly understood. Using kinematic and clinical outcomes, we examined spasticity in individuals with subacute and chronic injuries of different severity. We found that spasticity in the quadriceps femoris muscle was more prevalent among individuals with subacute motor incomplete than in those with motor complete injuries. However, in a different group of individuals with chronic injuries, no differences were found in the prevalence of spasticity across injury severity.
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Affiliation(s)
| | - Monica A Perez
- Shirley Ryan AbilityLab, Chicago, Illinois
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois
- Edward Hines Jr., VA Hospital, Hines, Illinois
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22
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Dengler J, Steeves JD, Curt A, Mehra M, Novak CB, Fox IK. Spontaneous Motor Recovery after Cervical Spinal Cord Injury: Issues for Nerve Transfer Surgery Decision Making. Spinal Cord 2022; 60:922-927. [PMID: 35896613 DOI: 10.1038/s41393-022-00834-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To quantify spontaneous upper extremity motor recovery between 6 and 12 months after spinal cord injury (SCI) to help guide timing of nerve transfer surgery to improve upper limb function in cervical SCI. SETTING Nineteen European SCI rehabilitation centers. METHODS Data was extracted from the European Multicenter Study of SCI database for individuals with mid-level cervical SCI (N = 268). Muscle function grades at 6 and 12 months post-SCI were categorized for analysis. RESULTS From 6 to 12 months after SCI, spontaneous surgically-relevant recovery was limited. Of all limbs (N = 263) with grade 0-2 elbow extension at 6 months, 4% regained grade 4-5 and 11% regained grade 3 muscle function at 12 months. Of all limbs (N = 380) with grade 0-2 finger flexion at 6 months, 3% regained grade 4-5 and 5% regained grade 3 muscle function at 12 months. CONCLUSION This information supports early (6 month) post-injury surgical consultation and evaluation. With this information, individuals with SCI can more fully engage in preference-based decision-making about surgical intervention versus continued rehabilitation and spontaneous recovery to gain elbow extension and/or hand opening and closing.
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Affiliation(s)
- Jana Dengler
- Division of Plastic and Reconstructive Surgery, Tory Trauma Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,University of Toronto, Division of Plastic & Reconstructive Surgery, Toronto, Ontario, Canada
| | - John D Steeves
- ICORD, University of British Columbia, Vancouver British Columbia, Vancouver, Canada
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Munish Mehra
- Tigermed-BDM Inc, Gaithersburg Maryland, Maryland, USA
| | - Christine B Novak
- University of Toronto, Division of Plastic & Reconstructive Surgery, Toronto, Ontario, Canada
| | | | | | - Ida K Fox
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis Missouri, USA. .,VA St. Louis Healthcare System, St Louis Missouri, USA.
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23
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Silverman J, Dengler J, Song C, Robinson LR. Pre-operative electrodiagnostic planning for upper limb peripheral nerve transfers in cervical spinal cord injury: A Narrative Review. PM R 2022. [PMID: 35726540 DOI: 10.1002/pmrj.12868] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 02/13/2022] [Accepted: 05/31/2022] [Indexed: 11/08/2022]
Abstract
Peripheral nerve transfer (PNT) to improve upper limb function following cervical spinal cord injury (SCI) involves the transfer of supralesional donor nerves under voluntary control to intralesional or sublesional lower motor neurons not under voluntary control. Appropriate selection of donor and recipient nerves and surgical timing impact functional outcomes. While the gold standard of nerve selection is intra-operative nerve stimulation, preoperative electrodiagnostic (EDX) evaluation may help guide surgical planning. Currently there is no standardized preoperative EDX protocol. This study reviews the EDX workup preceding peripheral nerve transfer surgery in cervical SCI, and proposes an informed EDX protocol to assist with surgical planning. The PICO (Population, Intervention, Comparison, Outcome) framework was used to formulate relevant MeSH terms and identify published cases of PNT in cervical SCI in Medline, Embase, CINAHL, and Emcare databases in the last 10 years. The electrodiagnostic techniques evaluating putative donor nerves, recipient nerve branches, time-sensitivity of nerve transfer and other electrophysiological parameters were summarized to guide creation of a preoperative EDX protocol. Needle electromyography (EMG) was the most commonly used EDX technique to identify healthy donor nerves. Although needle EMG has also been used on recipient nerves, compound muscle action potential (CMAP) amplitudes may provide a more accurate determination of recipient nerve health and time-sensitivity for nerve transfer. While there has been progress in pre-surgical EDX evaluation, EMG and NCS approaches are quite variable, and each has limitations in their utility for pre-operative planning. There is need for standardization in the EDX evaluation preceding peripheral nerve transfer surgery to assist with donor and recipient nerve selection, surgical timing and to optimize outcomes. Based on results of this review, herein we propose the PreSCIse (PRotocol for Electrodiagnosis in SCI Surgery of the upper Extremity) pre-operative EDX panel to achieve said goals through an interdisciplinary and patient-centered approach. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jordan Silverman
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jana Dengler
- Division of Plastic and Reconstructive Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Cimon Song
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lawrence R Robinson
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
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24
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Kim KD, Lee KS, Coric D, Harrop JS, Theodore N, Toselli RM. Acute Implantation of a Bioresorbable Polymer Scaffold in Patients With Complete Thoracic Spinal Cord Injury: 24-Month Follow-up From the INSPIRE Study. Neurosurgery 2022; 90:668-675. [PMID: 35442254 PMCID: PMC9067089 DOI: 10.1227/neu.0000000000001932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/24/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Based on 6-month data from the InVivo Study of Probable Benefit of the Neuro-Spinal Scaffold for Safety and Neurological Recovery in Patients with Complete Thoracic Spinal Cord Injury (INSPIRE) study (NCT02138110), acute implantation of an investigational bioresorbable polymer device (Neuro-Spinal Scaffold [NSS]) appeared to be safe in patients with complete thoracic spinal cord injury (SCI) and was associated with an ASIA Impairment Scale (AIS) conversion rate that exceeded historical controls. OBJECTIVE To evaluate outcomes through 24 months postimplantation. METHODS INSPIRE was a prospective, open-label, multicenter, single-arm study. Eligible patients had traumatic nonpenetrating SCI with a visible contusion on MRI, AIS A classification, neurological level of injury at T2-T12, and requirement for open spine surgery ≤96 hours postinjury. RESULTS Nineteen patients underwent NSS implantation. Three patients had early death determined by investigators to be unrelated to the NSS or its implantation procedure. Seven of 16 evaluable patients (44%) had improvement of ≥1 AIS grade at 6 months (primary end point) to AIS B (n = 5) or AIS C (n = 2). Three patients with AIS B at 6 months had further neurological improvement to AIS C by 12 (n = 2) and 24 (n = 1) months, respectively; none have deteriorated per latest available follow-up. No unanticipated or serious adverse device effects were reported. CONCLUSION In this small group of patients with complete thoracic SCI, acute NSS implantation within the spinal cord appeared to be safe with no long-term neurological issues identified during the 24-month follow-up. Patients remain stable, with additional AIS conversions observed in some patients at 12 months and beyond. These data further support the safety and probable benefit of NSS implantation in this patient population.
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Affiliation(s)
- Kee D. Kim
- Department of Neurological Surgery, UC Davis, Sacramento, California, USA;
| | - K. Stuart Lee
- Division of Neurosurgery, Vidant Health, Greenville, North Carolina, USA;
| | - Domagoj Coric
- Department of Neurosurgery, Atrium Healthcare, Charlotte, North Carolina, USA;
- Spine Division, Atrium Musculoskeletal Institute, Charlotte, North Carolina, USA;
- Carolina NeuroSurgery and Spine Associates, Charlotte, North Carolina, USA;
| | - James S. Harrop
- Department of Neurological and Orthopedic Surgery, Division of Spine and Peripheral Nerve Surgery, and Delaware Valley SCI Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA;
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA;
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25
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Sun F, Zhang H, Huang T, Shi J, Wei T, Wang Y. S100A9 blockade improves the functional recovery after spinal cord injury via mediating neutrophil infiltration. Exp Ther Med 2022; 23:291. [PMID: 35317450 PMCID: PMC8908460 DOI: 10.3892/etm.2022.11220] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/27/2022] [Indexed: 11/18/2022] Open
Abstract
Spinal cord injury (SCI) refers to damage to the spinal cord resulting from trauma, disease or degeneration. Controlling the inflammatory process and restoring neural homeostasis is hypothesized to prevent injury aggravation. S100 calcium-binding protein A9 (S100A9) is a pro-inflammatory alarm protein, which is expressed in and released by activated neutrophils. However, whether S100A9 could serve as an effective target for the treatment of SCI has not been reported to date. In the present study, a T10 spinal cord contusion injury model was established in Sprague-Dawley rats. S100A9 expression level was determined in the serum and injured spinal cord tissue via ELISA, reverse transcription-quantitative PCR (RT-qPCR) and western blotting. The S100A9-specific blocker, ABR-238901 (ABR), was administered during the inflammatory phase of SCI, as a form of treatment. Subsequently, the morphological structure, neuronal viability and inflammatory levels of injured spinal cord were observed by histopathology, immunohistochemistry and RT-qPCR. In the obtained results, S100A9 was found to be highly expressed in the injured spinal cord and serum in the first 3 days after SCI. However, at 28 days after surgery, ABR treatment significantly improved motor function, reduced the cavity formation and neutrophil infiltration in the lesion, which was verified via H&E staining and immunohistochemistry for myeloperoxidase. Furthermore, ABR treatment was found to effectively improve the survival and viability of neurons, as shown via Nissl staining and immunofluorescence of the synaptic plasticity markers, microtubule associated protein 2 and neurofilament 200. Moreover, S100A9 blockade effectively upregulated the mRNA expression level of the anti-inflammatory genes, IL-4 and IL-10 and downregulated the mRNA expression level of the pro-inflammatory factors, IL-1β, IL-6 and TNF-α. In addition, S100A9 blockade notably alleviated the apoptosis level of the injured nerve cells. Therefore, the findings of the present study revealed that S100A9 may be a useful target for the treatment of SCI.
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Affiliation(s)
- Feng Sun
- Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150000, P.R. China
| | - Haiwei Zhang
- Imaging, General Hospital of Heilongjiang General Administration of Agriculture and Reclamation, Harbin, Heilongjiang 150000, P.R. China
| | - Tianwen Huang
- Department of Orthopedics, General Hospital of Heilongjiang General Administration of Agriculture and Reclamation, Harbin, Heilongjiang 150000, P.R. China
| | - Jianhui Shi
- Department of Orthopaedics, Heilongjiang Provincial Hospital, Harbin, Heilongjiang 150000, P.R. China
| | - Tianli Wei
- Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150000, P.R. China
| | - Yansong Wang
- Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150000, P.R. China
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26
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Kisala PA, Boulton AJ, Slavin MD, Cohen ML, Keeney T, Ni P, Tate D, Heinemann AW, Charlifue S, Fyffe DC, Felix ER, Jette AM, Tulsky DS. Spinal Cord Injury-Functional Index/Capacity: Responsiveness to Change Over Time. Arch Phys Med Rehabil 2022; 103:199-206. [PMID: 34717921 PMCID: PMC8810572 DOI: 10.1016/j.apmr.2021.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 09/21/2021] [Accepted: 10/01/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To establish responsiveness of 3 Spinal Cord Injury-Functional Index/Capacity (SCI-FI/C) item banks in the first year after spinal cord injury (SCI). DESIGN Longitudinal patient-reported outcomes assessment replicated through secondary analysis of an independent data set. SETTING A total of 8 SCI Model Systems rehabilitation hospitals in the United States. PARTICIPANTS Study 1 participants included 184 adults with recent (≤4 months) traumatic SCI and 221 community-dwelling adults (>1 year post injury) (N=405). Study 2 participants were 418 individuals with recent SCI (≤4 months) (N=418). INTERVENTIONS In study 1, SCI-FI/C computer adaptive tests were presented in a standardized interview format either in person or by phone call at baseline and 6-month follow-up. Responsiveness was examined by comparing 6-month changes in SCI-FI scores within and across samples (recently injured vs community-dwelling) because only the recent injury sample was expected to exhibit change over time. Effect sizes were also computed. In study 2, the study 1 results were cross-validated in a second sample with recent SCI 1 year after baseline measurement. Study 2 also compared the SCI-FI/C measures' responsiveness to that of the Self-reported Functional Measure (SRFM) and stratified results by injury diagnosis and completeness. MAIN OUTCOME MEASURES The SCI-FI Basic Mobility/C, Self-care/C and Fine Motor/C item banks (study 1 and study 2); Self-reported Functional Measure SRFM (study 2 only). RESULTS In study 1, changes in SCI-FI/C scores between baseline and 6-month follow-up were statistically significant (P<.01) for recently injured individuals. SCI-FI Basic Mobility/C, Self-care/C, and Fine Motor/C item banks demonstrated small to medium effect sizes in the recently injured sample. In the community-dwelling sample, all SCI-FI/C effects were negligible (ie, effect size<0.08). Study 2 results were similar to study 1. As expected, SCI-FI Basic Mobility/C and Self-care/C were responsive to change for all individuals in study 2, whereas the SCI-FI Fine Motor/C was responsive only for individuals with tetraplegia and incomplete paraplegia. The SRFM demonstrated a medium effect size for responsiveness (effect size=0.65). CONCLUSIONS The SCI-FI Basic Mobility/C and Self-care/C banks demonstrate adequate sensitivity to change at 6 months and 1 year for all individuals with SCI, while the SCI-FI/C Fine Motor item bank is sensitive to change in individuals with tetraplegia or incomplete paraplegia. All SCI-FI/C banks demonstrate stability in a sample not expected to change. Results provide support for the use of these measures for research or clinical use.
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Affiliation(s)
- Pamela A. Kisala
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE
| | - Aaron J. Boulton
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE
| | - Mary D. Slavin
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
| | - Matthew L. Cohen
- Dept. of Communication Sciences and Disorders and Center for Health Assessment Research and Translation, University of Delaware, Newark, DE
| | - Tamra Keeney
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital,Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital
| | - Pengsheng Ni
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
| | - Denise Tate
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Allen W. Heinemann
- Shirley Ryan AbilityLab and Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Denise C. Fyffe
- Kessler Foundation, West Orange, NJ and New Jersey Medical School, Newark, NJ
| | - Elizabeth R. Felix
- Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, FL
| | - Alan M. Jette
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital
| | - David S. Tulsky
- Center for Health Assessment Research and Translation and Departments of Physical Therapy and Psychological and Brain Sciences, University of Delaware, Newark, DE
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27
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Grassner L, Garcia-Ovejero D, Mach O, Lopez-Dolado E, Vargas-Vaquero E, Alcobendas M, Esclarin A, Sanktjohanser L, Wutte C, Becker J, Lener S, Hartmann S, Girod PP, Koegl N, Griessenauer C, Papadopoulos MC, Geisler F, Thomé C, Molina-Holgado E, Vidal J, Curt A, Scivoletto G, Guest J, Maier D, Weidner N, Rupp R, Kramer JLK, Arevalo-Martin A. A NEW SCORE BASED ON THE INTERNATIONAL STANDARDS FOR NEUROLOGICAL CLASSIFICATION OF SPINAL CORD INJURY FOR INTEGRATIVE EVALUATION OF CHANGES IN SENSORIMOTOR FUNCTIONS. J Neurotrauma 2021; 39:613-626. [PMID: 34937399 DOI: 10.1089/neu.2021.0368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Sensorimotor function of patients with spinal cord injury (SCI) is commonly assessed according to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). From the ISNCSCI segmental motor and sensory assessments, upper and lower extremity motor scores (UEMS and LEMS), sum scores of pin prick (PP) and light touch (LT) sensation, the neurological level of injury (NLI) and the classification of lesion severity according to the American Spinal Injury Association Impairment Scale (AIS) grade are derived. Changes of these parameters over time are widely used to evaluate neurological recovery. However, evaluating recovery based on a single ISNCSCI scoring or classification variable may misestimate overall recovery. Here, we propose an Integrated Neurological Change Score (INCS) based on the combination of normalized changes between two-time points of UEMS, LEMS, and total PP and LT scores. To assess the agreement of INCS with clinical judgement of meaningfulness of neurological changes, changes of ISNCSCI variables between two time-points of 88 patients from an independent cohort were rated by 20 clinical experts according to a 5-categories Likert Scale. As for individual ISNCSCI variables, neurological change measured by INCS is associated to severity (AIS grade), age and time since injury, but INCS better reflects clinical judgment about meaningfulness of neurological changes than individual ISNCSCI variables. In addition, INCS is related with changes in functional independence measured by the Spinal Cord Independence Measure (SCIM) in patients with tetraplegia. INCS may be a useful measure of overall neurological change in clinical studies.
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Affiliation(s)
- Lukas Grassner
- Innsbruck Medical University Department of Neurology and Neurosurgery, 417777, Innsbruck, Tirol, Austria.,Paracelsus Medical University Salzburg, 31507, Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Salzburg, Austria;
| | - Daniel Garcia-Ovejero
- Hospital Nacional de Parapléjicos, SESCAM, Laboratorio de Neuroinflamación, Finca La Peraleda, Toledo, Spain, 45071;
| | - Orpheus Mach
- Trauma Center Murnau, Center for Spinal Cord Injuries, Prof.-Kuentscher-Str. 8, Murnau, Germany, 82418;
| | - Elisa Lopez-Dolado
- Hospital Nacional de Paraplejicos, Physical Medicine and Rehabilitation, Toledo, Spain;
| | | | - Monica Alcobendas
- Hospital Nacional de Paraplejicos, Physical Medicine and Rehabilitation, Toledo, Spain;
| | - Ana Esclarin
- HOSPITAL NACIONAL DE PARAPLEJICOS, Physical Medicine and Rehabilitation, Finca de la Peraleda S/N, Toledo, Toledo, Spain, 45007.,Fund;
| | | | - Christof Wutte
- Trauma Center Murnau, Center for Spinal Cord Injuries, Murnau, Germany;
| | - Johannes Becker
- Trauma Center Murnau, Center for Spinal Cord Injuries, Murnau, Germany;
| | - Sara Lener
- Innsbruck Medical University Department of Neurology and Neurosurgery, 417777, Innsbruck, Tirol, Austria;
| | - Sebastian Hartmann
- Innsbruck Medical University Department of Neurology and Neurosurgery, 417777, Innsbruck, Tirol, Austria;
| | - Pierre-Pascal Girod
- Innsbruck Medical University Department of Neurology and Neurosurgery, 417777, Innsbruck, Tirol, Austria;
| | - Nikolaus Koegl
- Innsbruck Medical University Department of Neurology and Neurosurgery, 417777, Innsbruck, Tirol, Austria;
| | - Christoph Griessenauer
- Geisinger Health System, 2780, Neurosurgery, Danville, Pennsylvania, United States.,Harvard Medical School, 1811, Neurological Surgery, Boston, Massachusetts, United States;
| | - Marios C Papadopoulos
- St George's University of London, Academic Neurosurgery Unit, St George's, University of London, 1.122 Jenner Wing, Cranmer Terrace, London, United Kingdom of Great Britain and Northern Ireland, SW17 0RE;
| | - Fred Geisler
- University of Saskatchewan College of Medicine, 12371, Saskatoon, Saskatchewan, Canada;
| | - Claudius Thomé
- Medical University Innsbruck, Dept. of Neurosurgery, Anichstr. 35, Innsbruck, Austria, 6020;
| | - Eduardo Molina-Holgado
- Hospital Nacional de Parapléjicos, SESCAM, Laboratorio de Neuroinflamación, Finca La Peraleda s/n, Toledo, Spain, 45071;
| | - Joan Vidal
- Institut Guttmann, 83068, Badalona, Catalunya, Spain;
| | - Armin Curt
- University Hospital Balgrist, Spinal Cord Injury Center, Forchstrasse, Zurich, Switzerland, 8008;
| | - Giorgio Scivoletto
- IRCCS Fondazioen S. Lucia, Spinal Cord Unit, via Ardeatina 306, Rome, Italy, 00179;
| | - James Guest
- University of Miami, Neurological Surgery, 1095 NW 14th Terrace, Miami, Florida, United States, 33136;
| | - Doris Maier
- Trauma Center Murnau, Center for Spinal Cord Injuries, Murnau, Germany;
| | - Norbert Weidner
- University Hospital Heidelberg, Spinal Cord Injury Center, Schlierbacher Landstr, Heidelberg, Germany, 69118;
| | - Rüdiger Rupp
- University Hospital Heidelberg, Spinal Cord Injury Center, Schlierbacher Landstr. 200a, Heidelberg, BW, Germany, 69118;
| | - John L K Kramer
- University of British Columbia International Collaboration on Repair Discoveries, 507272, Vancouver, British Columbia, Canada;
| | - Angel Arevalo-Martin
- Hospital Nacional de Paraplejicos, Laboratory of Neuroinflammation, Finca la Peraleda, s/n, Toledo, Spain, 45071;
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Zieriacks A, Aach M, Brinkemper A, Koller D, Schildhauer TA, Grasmücke D. Rehabilitation of Acute Vs. Chronic Patients With Spinal Cord Injury With a Neurologically Controlled Hybrid Assistive Limb Exoskeleton: Is There a Difference in Outcome? Front Neurorobot 2021; 15:728327. [PMID: 34776919 PMCID: PMC8578862 DOI: 10.3389/fnbot.2021.728327] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/04/2021] [Indexed: 11/30/2022] Open
Abstract
This study aimed to assess the outcome of acute and chronic participants with spinal cord injury (SCI) after 12 weeks of bodyweight supported treadmill training (BWSTT) with a hybrid assistive limb exoskeleton (HAL). Acute participants were defined as ≤12 months between SCI and training, chronic participants >12 months between SCI and training. We assessed whether HAL-assisted BWSTT is advantageous for acute and chronic participants and if length of time post injury impacts the outcome of HAL-assisted BWSTT. As the primary outcome, we assessed the time needed for the 10 meter walk test (10MWT). Hundred and twenty-one individuals participated in a 12-week HAL-assisted BWSTT five times a week. We regularly conducted a 10MWT, a 6 minute walk test (6MWT), and assessed the walking index for spinal cord injury (WISCI II) and lower extremity motor score (LEMS) to evaluate the gait performance without the exoskeleton. Distance and time were recorded by the treadmill while the participant was walking with the exoskeleton. All participants benefit from the 12-week HAL-assisted BWSTT. A significant difference between acute and chronic participants' outcomes was found in 6MWT, LEMS, and WISCI II, though not in 10MWT. Although chronic participants improved significantly lesser than acute participants, they did improve their outcome significantly compared to the beginning. Hybrid assistive limb-assisted BWSTT in the rehabilitation of patients with SCI is advantageous for both acute and chronic patients. We could not define a time related cut-off threshold following SCI for effectiveness of HAL-assisted BWSTT.
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Affiliation(s)
- Amrei Zieriacks
- Department of Spinal Cord Injuries, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Mirko Aach
- Department of Spinal Cord Injuries, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Alexis Brinkemper
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Daniela Koller
- Institute for Medical Information Processing, Biometrics and Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | | | - Dennis Grasmücke
- Department of Spinal Cord Injuries, BG University Hospital Bergmannsheil, Bochum, Germany
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29
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Hsieh YL, Tay J, Hsu SH, Chen WT, Fang YD, Liew CQ, Chou EH, Wolfshohl J, d'Etienne J, Wang CH, Tsuang FY. Early versus Late Surgical Decompression for Traumatic Spinal Cord Injury on Neurological Recovery: A Systematic Review and Meta-Analysis. J Neurotrauma 2021; 38:2927-2936. [PMID: 34314253 DOI: 10.1089/neu.2021.0102] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study aimed to investigate whether early surgical decompression was associated with favorable neurological recovery in patients with traumatic spinal cord injury (tSCI). We searched PubMed and Embase from the database inception through December 2020 and selected studies comparing the impact of early versus late surgical decompression on neurological recovery as assessed by American Spinal Injury Association Impairment Scale (AIS) for adult patients sustaining tSCI. We pooled the effect estimates in random-effects models and quantified the heterogeneity by the I2 statistics. Subgroup analysis and meta-regression analysis was conducted to identify significant outcome moderator. We included 26 studies involving 3574 patients in the meta-analysis. The pooled results demonstrated significant association between early surgical decompression and an improvement of at least one AIS grade (odds ratio [OR], 1.85; 95% confidence interval [CI], 1.41-2.41; I2, 48.06%). The benefits of early surgical decompression were consistently observed across different subgroups, including patients with cervical or thoracolumbar injury and patients with complete or incomplete injury. The meta-regression analysis indicated that cut-off timing defining early versus late decompression was a significant effect moderator, with early decompression performed before post-tSCI 8 or 12 h associated with greatest benefits (OR, 3.37; 95% CI, 1.74-6.50; I2, 53.52%). No obvious publication bias was detected by the funnel plot. In conclusion, early surgical decompression was associated with favorable neurological recovery for tSCI patients. However, there was a lack of high-quality evidence and the results need further examination.
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Affiliation(s)
- Yu-Lin Hsieh
- Department of Internal Medicine, Danbury Hospital, Danbury, Connecticut, USA
| | - Joyce Tay
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Hsien Hsu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Ting Chen
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-De Fang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chiat-Qiao Liew
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Eric H Chou
- Department of Emergency Medicine, Baylor Scott and White All Saints Medical Center, Fort Worth, Texas, USA
| | - Jon Wolfshohl
- Department of Emergency Medicine, Baylor Scott and White All Saints Medical Center, Fort Worth, Texas, USA
| | - James d'Etienne
- Department of Emergency Medicine, John Peter Smith Hospital, Fort Worth, Texas, USA
| | - Chih-Hung Wang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University, Taipei, Taiwan
| | - Fon-Yih Tsuang
- Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan
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30
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Tulsky DS, Boulton AJ, Kisala PA, Heinemann AW, Charlifue S, Kalpakjian C, Kozlowski AJ, Felix ER, Fyffe DC, Slavin MD, Tate DG. Physical Function Recovery Trajectories following Spinal Cord Injury. Arch Phys Med Rehabil 2021; 103:215-223. [PMID: 34678295 DOI: 10.1016/j.apmr.2021.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 08/21/2021] [Accepted: 09/20/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Explore trajectories of functional recovery that occur during the first two years after spinal cord injury (SCI). DESIGN Observational cohort study. SETTING Eight SCI Model System sites. PARTICIPANTS 479 adults with SCI completed four Spinal Cord Injury-Functional Index (SCI-FI) item banks within 4 months of injury and again at 2 weeks, 3, 6, 12, and 24 months following baseline assessment. INTERVENTION None. MAIN OUTCOME MEASURES SCI-FI Basic Mobility/Capacity (C), Fine Motor Function/C, Self-Care/C, and Wheelchair Mobility/Assistive Technology (AT) item banks. RESULTS Growth mixture modeling was used to identify groups with similar trajectory patterns. For the Basic Mobility/C and Wheelchair Mobility/AT domains, models specifying 2 trajectory groups were selected. For both domains, a majority class exhibited average functional levels and gradual improvement, primarily in the first six months. A smaller group of individuals made gradual improvements but had greater initial functional limitations. The Self Care/C domain exhibited a similar pattern; however, a third, small class emerged that exhibited substantial improvement in the first six months. Finally, for individuals with tetraplegia, trajectories of Fine Motor Function/C scores followed two patterns, with individuals reporting generally low initial scores and then making either modest or large improvements. In individual growth curve models, injury/demographic factors predicted initial functional levels but less so with regard to rates of recovery. CONCLUSIONS Trajectories of functional recovery followed a small number of change patterns, though variation around these patterns emerged. During the first two years after initial hospitalization, SCI-FI scores showed modest improvements; however, substantial improvements were noted for a small number of individuals with severe limitations in fine motor and self-care function. Future studies should further explore the personal, medical, and environmental characteristics that influence functional trajectories during these first two years and beyond.
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Affiliation(s)
- David S Tulsky
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE; Departments of Physical Therapy and Psychological & Brain Sciences, University of Delaware, Newark, DE.
| | - Aaron J Boulton
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE
| | - Pamela A Kisala
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE
| | - Allen W Heinemann
- Shirley Ryan AbilityLab, Chicago, IL; Northwestern University Feinberg School of Medicine, Department of Physical Medicine and Rehabilitation
| | | | - Claire Kalpakjian
- University of Michigan Medical School, Department of Physical Medicine & Rehabilitation, Ann Arbor, MI
| | - Allan J Kozlowski
- Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI; Michigan State University College of Human Medicine, Department of Epidemiology and Biostatistics, Grand Rapids, MI
| | - Elizabeth R Felix
- University of Miami Miller School of Medicine, Department of Physical Medicine & Rehabilitation, Miami, FL
| | - Denise C Fyffe
- Kessler Foundation, East Hanover, NJ; Rutgers-New Jersey Medical School, Newark, NJ
| | - Mary D Slavin
- Boston University School of Public Health, Boston, MA
| | - Denise G Tate
- University of Michigan Medical School, Department of Physical Medicine & Rehabilitation, Ann Arbor, MI
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31
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Engel-Haber E, Radomislensky I, Peleg K, Bodas M, Bondi M, Noy S, Zeilig G. Early Trauma Predictors of Mobility in People with Spinal Cord Injury. Spine (Phila Pa 1976) 2021; 46:E1089-E1096. [PMID: 33813583 DOI: 10.1097/brs.0000000000004053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE This study aims to assess the potential value of very early trauma variables such as Abbreviated Injury Scale (AIS) and the Injury Severity Score for predicting independent ambulation following a traumatic spinal cord injury (TSCI). SUMMARY OF BACKGROUND DATA Several models for prediction of ambulation early after TSCI have been published and validated. The vast majority rely on the initial examination of American Spinal Injury Association (ASIA) impairment scale and level of injury; however, in many locations and clinical situations this examination is not feasible early after the injury. METHODS Patient characteristics, trauma data, and ASIA scores on admission to rehabilitation were collected for each of the 144 individuals in the study. Outcome measure was the indoor mobility item of the Spinal Cord Independence Measure taken upon discharge from rehabilitation. Univariate and multivariable models were created for each predictor, Odds ratios (ORs) were obtained by a multivariable logistic regression analysis, and area under the receiver operator curve was calculated for each model. RESULTS We observed a significant correlation between the trauma variables and independent ambulation upon discharge from rehabilitation. Of the early variables, the AIS for the spine region showed the strongest correlation. CONCLUSION These findings support using preliminary trauma variables for early prognostication of ambulation following a TSCI, allowing for tailored individual interventions.Level of Evidence: 3.
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Affiliation(s)
- Einat Engel-Haber
- Department of Neurological Rehabilitation, The Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Irina Radomislensky
- Israel National Centre for Trauma and Emergency Medicine Research, The Gertner institute for Epidemiology and Health Policy Research, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Kobi Peleg
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Israel National Centre for Trauma and Emergency Medicine Research, The Gertner institute for Epidemiology and Health Policy Research, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Moran Bodas
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Israel National Centre for Trauma and Emergency Medicine Research, The Gertner institute for Epidemiology and Health Policy Research, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Moshe Bondi
- Department of Neurological Rehabilitation, The Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Shlomo Noy
- The Chaim Sheba Medical Center, Tel Hashomer, Israel
- School of Health Professions, Ono Academic College, Kiryat Ono, Israel
| | - Gabi Zeilig
- Department of Neurological Rehabilitation, The Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- School of Health Professions, Ono Academic College, Kiryat Ono, Israel
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32
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Moinuddin FM, Yolcu YU, Wahood W, Zreik J, Goncalves S, Windebank AJ, Qu W, Bydon M. Time-to-enrollment in clinical trials investigating neurological recovery in chronic spinal cord injury: observations from a systematic review and ClinicalTrials.gov database. Neural Regen Res 2021; 17:953-958. [PMID: 34558507 PMCID: PMC8552853 DOI: 10.4103/1673-5374.324826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Currently, large numbers of clinical trials are performed to investigate different forms of experimental therapy for patients suffering from chronic spinal cord injury (SCI). However, for the enrollment process, there are different views on how the time period between injury and interventions should be determined. Herein, we sought to evaluate the impact of time-to-enrollment in chronic SCI clinical trials. A data set comprising 957 clinical studies from clinicalTrials.gov was downloaded and analyzed focusing on the eligibility criteria for post-injury time-to-enrollment. We also aggregated individual patient data from nine clinical trials of regenerative interventions for chronic SCI selected by a systematic literature search from 1990 to 2018. Characteristics of the studies were assessed and compared by dividing into three groups based on time-to-enrollment (group 1 ≤ 12 months, group 2 = 12–23 months and group 3 ≥ 24 months). In ClinicalTrials.gov registry, 445 trials were identified for chronic SCI where 87% (385) were unrestricted in the maximum post-injury time for trial eligibility. From systematic literature search, nine studies and 156 patients (group 1 = 30, group 2 = 55 and group 3 = 71) were included. The range of time-to-enrollment was 0.5 to 321 months in those studies. We also observed various degrees of motor and sensory improvement in between three time-to-enrollment groups. Our results indicate that enrolling wide ranges of time-to-enrollment in a group may present imprecise outcomes. Clinical trial designs should consider appropriate post-injury time frames to evaluate therapeutic benefit.
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Affiliation(s)
- F M Moinuddin
- Mayo Clinic Neuro-Informatics Laboratory; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Yagiz Ugur Yolcu
- Mayo Clinic Neuro-Informatics Laboratory; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Waseem Wahood
- Mayo Clinic Neuro-Informatics Laboratory; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN; Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, FL, USA
| | - Jad Zreik
- Mayo Clinic Neuro-Informatics Laboratory; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sandy Goncalves
- Mayo Clinic Neuro-Informatics Laboratory; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Wenchun Qu
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Mohamad Bydon
- Mayo Clinic Neuro-Informatics Laboratory; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
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33
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Dengler J, Mehra M, Steeves JD, Fox IK. Evaluation of Functional Independence in Cervical Spinal Cord Injury: Implications for Surgery to Restore Upper Limb Function. J Hand Surg Am 2021; 46:621.e1-621.e17. [PMID: 33454154 DOI: 10.1016/j.jhsa.2020.10.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 08/18/2020] [Accepted: 10/22/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To help individuals make informed choices regarding the optimal type and timing of restorative surgical treatment for cervical spinal cord injury (SCI), more precise information is needed on their ability to perform activities of daily living. The goal of this work was to describe functional independence achieved by individuals with differing levels of cervical SCI. METHODS Using the comprehensive European Multicenter Study of Spinal Cord Injury dataset, analysis was undertaken of individuals with traumatic SCI, motor-level C5-C8. Data on feeding, bladder management, and transfers (bed to wheelchair) were compared between individuals with different levels of injury. Subgroup analyses of symmetrical and asymmetrical SCI and between complete and incomplete SCI were performed. The impact of age, sex, and time postinjury on functional independence was ascertained. RESULTS Data were available for individuals with symmetrical (n = 204) and asymmetrical (n = 95) patterns of SCI. Independence with feeding, urinary function, and transfer ability was increased in individuals with strong finger flexion. Unexpectedly, the presence of strong elbow extension did not uniformly result in the ability to transfer independently. There was no change in any of the analyzed activities between 6 and 12 months postinjury. CONCLUSIONS People with cervical SCI who gain finger flexion have greater independence with feeding, urinary, and transfer activities. Restoration of finger flexion should be a reconstructive priority for individuals with midcervical-level SCI. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Jana Dengler
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario
| | | | - John D Steeves
- ICORD, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Ida K Fox
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO; VA St. Louis Healthcare System, St. Louis, MO.
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34
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Haddad AF, Burke JF, Dhall SS. The Natural History of Spinal Cord Injury. Neurosurg Clin N Am 2021; 32:315-321. [PMID: 34053719 DOI: 10.1016/j.nec.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The natural history of spinal cord injury is in a state of flux. Our knowledge about the prevalence, epidemiology, and natural history spinal cord injury is in evolution. In this article, we summarize these considerations to provide a state-of-the-art synopsis of the neurologic outcomes of this condition.
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Affiliation(s)
- Alexander F Haddad
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M779, San Francisco, CA 94143, USA
| | - John F Burke
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M779, San Francisco, CA 94143, USA
| | - Sanjay S Dhall
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M779, San Francisco, CA 94143, USA.
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35
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Jaja BNR, Badhiwala J, Guest J, Harrop J, Shaffrey C, Boakye M, Kurpad S, Grossman R, Toups E, Geisler F, Kwon B, Aarabi B, Kotter M, Fehlings MG, Wilson JR. Trajectory-Based Classification of Recovery in Sensorimotor Complete Traumatic Cervical Spinal Cord Injury. Neurology 2021; 96:e2736-e2748. [PMID: 33849991 DOI: 10.1212/wnl.0000000000012028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 03/01/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the hypothesis that sensorimotor complete traumatic cervical spinal cord injury (SCI) is a heterogenous clinical entity comprising several subpopulations that follow fundamentally different trajectories of neurologic recovery. METHODS We analyzed demographic and injury data from 655 patients who were pooled from 4 prospective longitudinal multicenter studies. Group-based trajectory modeling was applied to model neurologic recovery trajectories over the initial 12 months postinjury and to identify predictors of recovery trajectories. Neurologic outcomes included upper extremity motor score, total motor scores, and American Spinal Injury Association Impairment Scale (AIS) grade improvement. RESULTS The analysis identified 3 distinct trajectories of neurologic recovery. These clinical courses included (1) marginal recovery trajectory, characterized by minimal or no improvement in motor strength or change in AIS grade status (remained grade A); (2) moderate recovery trajectory, characterized by low baseline motor scores that improved approximately 13 points or AIS conversion of 1 grade point; (3) good recovery trajectory, characterized by baseline motor scores in the upper quartile that improved to near maximum values within 3 months of injury. Patients following the moderate or good recovery trajectories were younger, had more caudally located injuries, had a higher degree of preserved motor and sensory function at baseline examination, and exhibited a greater extent of motor and sensory function in the zone of partial preservation. CONCLUSION Cervical complete SCI can be classified into one of 3 distinct subpopulations with fundamentally different trajectories of neurologic recovery. This study defines unique clinical phenotypes based on potential for recovery, rather than baseline severity of injury alone. This approach may prove beneficial in clinical prognostication and in the design and interpretation of clinical trials in SCI.
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Affiliation(s)
- Blessing N R Jaja
- From the Division of Neurosurgery and Spine Program (B.N.R.J., M.G.F.), Toronto Western Hospital, Division of Neurosurgery and Spine Program (J.B.), and Division of Neurosurgery and Spine Program, St. Michael's Hospital (J.R.W.), University of Toronto, Canada; Division of Neurosurgery (J.G.), University of Miami, FL; Division of Neurosurgery (J.H.), Thomas Jefferson University Hospital, Philadelphia, PA; Duke Spine Division (C.S.), Duke University School of Medicine, Durham, NC; Division of Neurosurgery (M.B.), University of Louisville, KY; Division of Neurosurgery (S.K.), Medical College of Wisconsin, Milwaukee; Division of Neurosurgery (R.G., E.T.), Methodist Hospital, Houston, TX; Chicago Institute of Neurosurgery and Neuroresearch (F.G.), Rush University, IL; Division of Spine Surgery (B.K.), Vancouver General Hospital, University of British Columbia, Canada; Division of Neurosurgery, Shock Trauma (B.A.), University of Maryland, Baltimore; and Division of Neurosurgery, Department of Clinical Neurosciences (M.K.), University of Cambridge, UK
| | - Jetan Badhiwala
- From the Division of Neurosurgery and Spine Program (B.N.R.J., M.G.F.), Toronto Western Hospital, Division of Neurosurgery and Spine Program (J.B.), and Division of Neurosurgery and Spine Program, St. Michael's Hospital (J.R.W.), University of Toronto, Canada; Division of Neurosurgery (J.G.), University of Miami, FL; Division of Neurosurgery (J.H.), Thomas Jefferson University Hospital, Philadelphia, PA; Duke Spine Division (C.S.), Duke University School of Medicine, Durham, NC; Division of Neurosurgery (M.B.), University of Louisville, KY; Division of Neurosurgery (S.K.), Medical College of Wisconsin, Milwaukee; Division of Neurosurgery (R.G., E.T.), Methodist Hospital, Houston, TX; Chicago Institute of Neurosurgery and Neuroresearch (F.G.), Rush University, IL; Division of Spine Surgery (B.K.), Vancouver General Hospital, University of British Columbia, Canada; Division of Neurosurgery, Shock Trauma (B.A.), University of Maryland, Baltimore; and Division of Neurosurgery, Department of Clinical Neurosciences (M.K.), University of Cambridge, UK
| | - James Guest
- From the Division of Neurosurgery and Spine Program (B.N.R.J., M.G.F.), Toronto Western Hospital, Division of Neurosurgery and Spine Program (J.B.), and Division of Neurosurgery and Spine Program, St. Michael's Hospital (J.R.W.), University of Toronto, Canada; Division of Neurosurgery (J.G.), University of Miami, FL; Division of Neurosurgery (J.H.), Thomas Jefferson University Hospital, Philadelphia, PA; Duke Spine Division (C.S.), Duke University School of Medicine, Durham, NC; Division of Neurosurgery (M.B.), University of Louisville, KY; Division of Neurosurgery (S.K.), Medical College of Wisconsin, Milwaukee; Division of Neurosurgery (R.G., E.T.), Methodist Hospital, Houston, TX; Chicago Institute of Neurosurgery and Neuroresearch (F.G.), Rush University, IL; Division of Spine Surgery (B.K.), Vancouver General Hospital, University of British Columbia, Canada; Division of Neurosurgery, Shock Trauma (B.A.), University of Maryland, Baltimore; and Division of Neurosurgery, Department of Clinical Neurosciences (M.K.), University of Cambridge, UK
| | - James Harrop
- From the Division of Neurosurgery and Spine Program (B.N.R.J., M.G.F.), Toronto Western Hospital, Division of Neurosurgery and Spine Program (J.B.), and Division of Neurosurgery and Spine Program, St. Michael's Hospital (J.R.W.), University of Toronto, Canada; Division of Neurosurgery (J.G.), University of Miami, FL; Division of Neurosurgery (J.H.), Thomas Jefferson University Hospital, Philadelphia, PA; Duke Spine Division (C.S.), Duke University School of Medicine, Durham, NC; Division of Neurosurgery (M.B.), University of Louisville, KY; Division of Neurosurgery (S.K.), Medical College of Wisconsin, Milwaukee; Division of Neurosurgery (R.G., E.T.), Methodist Hospital, Houston, TX; Chicago Institute of Neurosurgery and Neuroresearch (F.G.), Rush University, IL; Division of Spine Surgery (B.K.), Vancouver General Hospital, University of British Columbia, Canada; Division of Neurosurgery, Shock Trauma (B.A.), University of Maryland, Baltimore; and Division of Neurosurgery, Department of Clinical Neurosciences (M.K.), University of Cambridge, UK
| | - Chris Shaffrey
- From the Division of Neurosurgery and Spine Program (B.N.R.J., M.G.F.), Toronto Western Hospital, Division of Neurosurgery and Spine Program (J.B.), and Division of Neurosurgery and Spine Program, St. Michael's Hospital (J.R.W.), University of Toronto, Canada; Division of Neurosurgery (J.G.), University of Miami, FL; Division of Neurosurgery (J.H.), Thomas Jefferson University Hospital, Philadelphia, PA; Duke Spine Division (C.S.), Duke University School of Medicine, Durham, NC; Division of Neurosurgery (M.B.), University of Louisville, KY; Division of Neurosurgery (S.K.), Medical College of Wisconsin, Milwaukee; Division of Neurosurgery (R.G., E.T.), Methodist Hospital, Houston, TX; Chicago Institute of Neurosurgery and Neuroresearch (F.G.), Rush University, IL; Division of Spine Surgery (B.K.), Vancouver General Hospital, University of British Columbia, Canada; Division of Neurosurgery, Shock Trauma (B.A.), University of Maryland, Baltimore; and Division of Neurosurgery, Department of Clinical Neurosciences (M.K.), University of Cambridge, UK
| | - Max Boakye
- From the Division of Neurosurgery and Spine Program (B.N.R.J., M.G.F.), Toronto Western Hospital, Division of Neurosurgery and Spine Program (J.B.), and Division of Neurosurgery and Spine Program, St. Michael's Hospital (J.R.W.), University of Toronto, Canada; Division of Neurosurgery (J.G.), University of Miami, FL; Division of Neurosurgery (J.H.), Thomas Jefferson University Hospital, Philadelphia, PA; Duke Spine Division (C.S.), Duke University School of Medicine, Durham, NC; Division of Neurosurgery (M.B.), University of Louisville, KY; Division of Neurosurgery (S.K.), Medical College of Wisconsin, Milwaukee; Division of Neurosurgery (R.G., E.T.), Methodist Hospital, Houston, TX; Chicago Institute of Neurosurgery and Neuroresearch (F.G.), Rush University, IL; Division of Spine Surgery (B.K.), Vancouver General Hospital, University of British Columbia, Canada; Division of Neurosurgery, Shock Trauma (B.A.), University of Maryland, Baltimore; and Division of Neurosurgery, Department of Clinical Neurosciences (M.K.), University of Cambridge, UK
| | - Shekar Kurpad
- From the Division of Neurosurgery and Spine Program (B.N.R.J., M.G.F.), Toronto Western Hospital, Division of Neurosurgery and Spine Program (J.B.), and Division of Neurosurgery and Spine Program, St. Michael's Hospital (J.R.W.), University of Toronto, Canada; Division of Neurosurgery (J.G.), University of Miami, FL; Division of Neurosurgery (J.H.), Thomas Jefferson University Hospital, Philadelphia, PA; Duke Spine Division (C.S.), Duke University School of Medicine, Durham, NC; Division of Neurosurgery (M.B.), University of Louisville, KY; Division of Neurosurgery (S.K.), Medical College of Wisconsin, Milwaukee; Division of Neurosurgery (R.G., E.T.), Methodist Hospital, Houston, TX; Chicago Institute of Neurosurgery and Neuroresearch (F.G.), Rush University, IL; Division of Spine Surgery (B.K.), Vancouver General Hospital, University of British Columbia, Canada; Division of Neurosurgery, Shock Trauma (B.A.), University of Maryland, Baltimore; and Division of Neurosurgery, Department of Clinical Neurosciences (M.K.), University of Cambridge, UK
| | - Robert Grossman
- From the Division of Neurosurgery and Spine Program (B.N.R.J., M.G.F.), Toronto Western Hospital, Division of Neurosurgery and Spine Program (J.B.), and Division of Neurosurgery and Spine Program, St. Michael's Hospital (J.R.W.), University of Toronto, Canada; Division of Neurosurgery (J.G.), University of Miami, FL; Division of Neurosurgery (J.H.), Thomas Jefferson University Hospital, Philadelphia, PA; Duke Spine Division (C.S.), Duke University School of Medicine, Durham, NC; Division of Neurosurgery (M.B.), University of Louisville, KY; Division of Neurosurgery (S.K.), Medical College of Wisconsin, Milwaukee; Division of Neurosurgery (R.G., E.T.), Methodist Hospital, Houston, TX; Chicago Institute of Neurosurgery and Neuroresearch (F.G.), Rush University, IL; Division of Spine Surgery (B.K.), Vancouver General Hospital, University of British Columbia, Canada; Division of Neurosurgery, Shock Trauma (B.A.), University of Maryland, Baltimore; and Division of Neurosurgery, Department of Clinical Neurosciences (M.K.), University of Cambridge, UK
| | - Elizabeth Toups
- From the Division of Neurosurgery and Spine Program (B.N.R.J., M.G.F.), Toronto Western Hospital, Division of Neurosurgery and Spine Program (J.B.), and Division of Neurosurgery and Spine Program, St. Michael's Hospital (J.R.W.), University of Toronto, Canada; Division of Neurosurgery (J.G.), University of Miami, FL; Division of Neurosurgery (J.H.), Thomas Jefferson University Hospital, Philadelphia, PA; Duke Spine Division (C.S.), Duke University School of Medicine, Durham, NC; Division of Neurosurgery (M.B.), University of Louisville, KY; Division of Neurosurgery (S.K.), Medical College of Wisconsin, Milwaukee; Division of Neurosurgery (R.G., E.T.), Methodist Hospital, Houston, TX; Chicago Institute of Neurosurgery and Neuroresearch (F.G.), Rush University, IL; Division of Spine Surgery (B.K.), Vancouver General Hospital, University of British Columbia, Canada; Division of Neurosurgery, Shock Trauma (B.A.), University of Maryland, Baltimore; and Division of Neurosurgery, Department of Clinical Neurosciences (M.K.), University of Cambridge, UK
| | - Fred Geisler
- From the Division of Neurosurgery and Spine Program (B.N.R.J., M.G.F.), Toronto Western Hospital, Division of Neurosurgery and Spine Program (J.B.), and Division of Neurosurgery and Spine Program, St. Michael's Hospital (J.R.W.), University of Toronto, Canada; Division of Neurosurgery (J.G.), University of Miami, FL; Division of Neurosurgery (J.H.), Thomas Jefferson University Hospital, Philadelphia, PA; Duke Spine Division (C.S.), Duke University School of Medicine, Durham, NC; Division of Neurosurgery (M.B.), University of Louisville, KY; Division of Neurosurgery (S.K.), Medical College of Wisconsin, Milwaukee; Division of Neurosurgery (R.G., E.T.), Methodist Hospital, Houston, TX; Chicago Institute of Neurosurgery and Neuroresearch (F.G.), Rush University, IL; Division of Spine Surgery (B.K.), Vancouver General Hospital, University of British Columbia, Canada; Division of Neurosurgery, Shock Trauma (B.A.), University of Maryland, Baltimore; and Division of Neurosurgery, Department of Clinical Neurosciences (M.K.), University of Cambridge, UK
| | - Brian Kwon
- From the Division of Neurosurgery and Spine Program (B.N.R.J., M.G.F.), Toronto Western Hospital, Division of Neurosurgery and Spine Program (J.B.), and Division of Neurosurgery and Spine Program, St. Michael's Hospital (J.R.W.), University of Toronto, Canada; Division of Neurosurgery (J.G.), University of Miami, FL; Division of Neurosurgery (J.H.), Thomas Jefferson University Hospital, Philadelphia, PA; Duke Spine Division (C.S.), Duke University School of Medicine, Durham, NC; Division of Neurosurgery (M.B.), University of Louisville, KY; Division of Neurosurgery (S.K.), Medical College of Wisconsin, Milwaukee; Division of Neurosurgery (R.G., E.T.), Methodist Hospital, Houston, TX; Chicago Institute of Neurosurgery and Neuroresearch (F.G.), Rush University, IL; Division of Spine Surgery (B.K.), Vancouver General Hospital, University of British Columbia, Canada; Division of Neurosurgery, Shock Trauma (B.A.), University of Maryland, Baltimore; and Division of Neurosurgery, Department of Clinical Neurosciences (M.K.), University of Cambridge, UK
| | - Bizhan Aarabi
- From the Division of Neurosurgery and Spine Program (B.N.R.J., M.G.F.), Toronto Western Hospital, Division of Neurosurgery and Spine Program (J.B.), and Division of Neurosurgery and Spine Program, St. Michael's Hospital (J.R.W.), University of Toronto, Canada; Division of Neurosurgery (J.G.), University of Miami, FL; Division of Neurosurgery (J.H.), Thomas Jefferson University Hospital, Philadelphia, PA; Duke Spine Division (C.S.), Duke University School of Medicine, Durham, NC; Division of Neurosurgery (M.B.), University of Louisville, KY; Division of Neurosurgery (S.K.), Medical College of Wisconsin, Milwaukee; Division of Neurosurgery (R.G., E.T.), Methodist Hospital, Houston, TX; Chicago Institute of Neurosurgery and Neuroresearch (F.G.), Rush University, IL; Division of Spine Surgery (B.K.), Vancouver General Hospital, University of British Columbia, Canada; Division of Neurosurgery, Shock Trauma (B.A.), University of Maryland, Baltimore; and Division of Neurosurgery, Department of Clinical Neurosciences (M.K.), University of Cambridge, UK
| | - Mark Kotter
- From the Division of Neurosurgery and Spine Program (B.N.R.J., M.G.F.), Toronto Western Hospital, Division of Neurosurgery and Spine Program (J.B.), and Division of Neurosurgery and Spine Program, St. Michael's Hospital (J.R.W.), University of Toronto, Canada; Division of Neurosurgery (J.G.), University of Miami, FL; Division of Neurosurgery (J.H.), Thomas Jefferson University Hospital, Philadelphia, PA; Duke Spine Division (C.S.), Duke University School of Medicine, Durham, NC; Division of Neurosurgery (M.B.), University of Louisville, KY; Division of Neurosurgery (S.K.), Medical College of Wisconsin, Milwaukee; Division of Neurosurgery (R.G., E.T.), Methodist Hospital, Houston, TX; Chicago Institute of Neurosurgery and Neuroresearch (F.G.), Rush University, IL; Division of Spine Surgery (B.K.), Vancouver General Hospital, University of British Columbia, Canada; Division of Neurosurgery, Shock Trauma (B.A.), University of Maryland, Baltimore; and Division of Neurosurgery, Department of Clinical Neurosciences (M.K.), University of Cambridge, UK
| | - Michael G Fehlings
- From the Division of Neurosurgery and Spine Program (B.N.R.J., M.G.F.), Toronto Western Hospital, Division of Neurosurgery and Spine Program (J.B.), and Division of Neurosurgery and Spine Program, St. Michael's Hospital (J.R.W.), University of Toronto, Canada; Division of Neurosurgery (J.G.), University of Miami, FL; Division of Neurosurgery (J.H.), Thomas Jefferson University Hospital, Philadelphia, PA; Duke Spine Division (C.S.), Duke University School of Medicine, Durham, NC; Division of Neurosurgery (M.B.), University of Louisville, KY; Division of Neurosurgery (S.K.), Medical College of Wisconsin, Milwaukee; Division of Neurosurgery (R.G., E.T.), Methodist Hospital, Houston, TX; Chicago Institute of Neurosurgery and Neuroresearch (F.G.), Rush University, IL; Division of Spine Surgery (B.K.), Vancouver General Hospital, University of British Columbia, Canada; Division of Neurosurgery, Shock Trauma (B.A.), University of Maryland, Baltimore; and Division of Neurosurgery, Department of Clinical Neurosciences (M.K.), University of Cambridge, UK
| | - Jefferson R Wilson
- From the Division of Neurosurgery and Spine Program (B.N.R.J., M.G.F.), Toronto Western Hospital, Division of Neurosurgery and Spine Program (J.B.), and Division of Neurosurgery and Spine Program, St. Michael's Hospital (J.R.W.), University of Toronto, Canada; Division of Neurosurgery (J.G.), University of Miami, FL; Division of Neurosurgery (J.H.), Thomas Jefferson University Hospital, Philadelphia, PA; Duke Spine Division (C.S.), Duke University School of Medicine, Durham, NC; Division of Neurosurgery (M.B.), University of Louisville, KY; Division of Neurosurgery (S.K.), Medical College of Wisconsin, Milwaukee; Division of Neurosurgery (R.G., E.T.), Methodist Hospital, Houston, TX; Chicago Institute of Neurosurgery and Neuroresearch (F.G.), Rush University, IL; Division of Spine Surgery (B.K.), Vancouver General Hospital, University of British Columbia, Canada; Division of Neurosurgery, Shock Trauma (B.A.), University of Maryland, Baltimore; and Division of Neurosurgery, Department of Clinical Neurosciences (M.K.), University of Cambridge, UK.
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Cajigas I, Vedantam A. Brain-Computer Interface, Neuromodulation, and Neurorehabilitation Strategies for Spinal Cord Injury. Neurosurg Clin N Am 2021; 32:407-417. [PMID: 34053728 DOI: 10.1016/j.nec.2021.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
As neural bypass interfacing, neuromodulation, and neurorehabilitation continue to evolve, there is growing recognition that combination therapies may achieve superior results. This article briefly introduces these broad areas of active research and lays out some of the current evidence for their use for patients with spinal cord injury.
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Affiliation(s)
- Iahn Cajigas
- Department of Neurosurgery, University of Miami, 1095 Northwest 14th Terrace (D4-6), Miami, FL 33136, USA.
| | - Aditya Vedantam
- Department of Neurosurgery, University of Miami, 1095 Northwest 14th Terrace (D4-6), Miami, FL 33136, USA
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37
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Ramey WL, Chapman JR. Spinal Cord Injury Clinical Classification Systems: What Is Available and a Proposed Alternative. Neurosurg Clin N Am 2021; 32:333-340. [PMID: 34053721 DOI: 10.1016/j.nec.2021.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Spinal cord injury (SCI) remains a challenging disease in terms of surgical decision-making and improving neurologic outcome. As we have now entered a new era founded on routine "big data" capture, more advanced and meaningful yet simplified SCI classification systems and outcome measurement tools would be helpful to determine the efficacy of potential therapeutics in future clinical trials and registries. The proposed classification herein focuses on gross sensorimotor, sacral function below the injured level via an easy-to-use scoring system yielding grades 1 to 4 of injury severity. Such an optimized SCI scoring system would enhance real-time analytics and offer superior outcomes modeling.
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Affiliation(s)
- Wyatt L Ramey
- Department of Neurosurgery, Banner University of Arizona Medical Center - Tucson, PO Box 245070, 1501 North Campbell Avenue, Room 4303, Tucson, AZ 85724-5070, USA.
| | - Jens R Chapman
- Department of Neurosurgery, Swedish Neuroscience Institute, 550 17th Avenue, Seattle, WA 98122, USA
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38
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Kirshblum S, Snider B, Eren F, Guest J. Characterizing Natural Recovery after Traumatic Spinal Cord Injury. J Neurotrauma 2021; 38:1267-1284. [PMID: 33339474 PMCID: PMC8080912 DOI: 10.1089/neu.2020.7473] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The predominant tool used to predict outcomes after traumatic spinal cord injury (SCI) is the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), in association with the American Spinal Injury Association (ASIA) Impairment Scale (AIS). These measures have evolved based on analyses of large amounts of longitudinal neurological recovery data published in numerous separate studies. This article reviews and synthesizes published data on neurological recovery from multiple sources, only utilizing data in which the sacral sparing definition was applied for determination of completeness. Conversion from a complete to incomplete injury is more common in tetraplegia than paraplegia. The majority of AIS conversion and motor recovery occurs within the first 6-9 months, with the most rapid rate of motor recovery occurring in the first three months after injury. Motor score changes, as well as recovery of motor levels, are described with the initial strength of muscles as well as the levels of the motor zone of partial preservation influencing the prognosis. Total motor recovery is greater for patients with initial AIS B than AIS A, and greater after initial AIS C than with motor complete injuries. Older age has a negative impact on neurological and functional recovery after SCI; however, the specific age (whether >50 or >65 years) and underlying reasons for this impact are unclear. Penetrating injury is more likely to lead to a classification of a neurological complete injury compared with blunt trauma and reduces the likelihood of AIS conversion at one year. There are insufficient data to support gender having a major effect on neurological recovery after SCI.
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Affiliation(s)
- Steven Kirshblum
- Kessler Institute for Rehabilitation, West Orange, New Jersy, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Kessler Foundation, West Orange, New Jersey, USA
| | - Brittany Snider
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Fatma Eren
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Kessler Foundation, West Orange, New Jersey, USA
| | - James Guest
- Neurological Surgery, Miller School of Medicine, Miami, Florida, USA
- The Miami Project to Cure Paralysis, Miami, Florida, USA
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39
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Carlstrom LP, Graffeo CS, Perry A, Klinkner DB, Daniels DJ. An arrow that missed the mark: a pediatric case report of remarkable neurologic improvement following penetrating spinal cord injury. Childs Nerv Syst 2021; 37:1771-1778. [PMID: 32754869 DOI: 10.1007/s00381-020-04842-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/28/2020] [Indexed: 11/25/2022]
Abstract
Penetrating spinal cord injuries are rare in children but result in devastating impacts on long-term morbidity and mortality-with little known about the recovery capacity in this age group. We present the case of an eight-year-old child who sustained a penetrating injury through the right anterior thorax. Thoracic CT showed the arrow tip extending through the spinal canal at T6. Neurologic examination revealed no motor or sensory function below T6. The arrow was surgically removed without complications through an anterior-only approach. MRI on post-operative day (POD) 4 showed focal T2 hyperintensity at the T6 spinal cord. Patient was discharged on POD33 with an American Spinal Injury Association (ASIA)-D score and trace voluntary control over bowel and bladder function. Remarkably, four months later, he had near normal bowel and bladder function, with near-intact lower extremity strength and self-sustained ambulation. Follow-up imaging revealed hemicord formation at the level of injury. We review our case of penetrating spinal cord injury in a child and similar reports in the literature. Penetrating thoracic spinal cord trauma portends poor clinical outcomes, particularly when employing available adult prognostic spinal cord injury scoring metrics. Incomplete spinal cord injury, and often-associated spinal shock, can mimic a complete injury-as in our patient, which improved to near-complete motor and sensory restoration of function and resulted in the formation of a split hemicord. This case represents a unique penetrating spinal cord injury with remarkable neurologic recovery, which would advocate against definitive early prognostication in the pediatric population.
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Affiliation(s)
- Lucas P Carlstrom
- Department of Neurological Surgery, Pediatric Neurosurgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Christopher S Graffeo
- Department of Neurological Surgery, Pediatric Neurosurgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Avital Perry
- Department of Neurological Surgery, Pediatric Neurosurgery, Mayo Clinic, Rochester, MN, 55905, USA
| | | | - David J Daniels
- Department of Neurological Surgery, Pediatric Neurosurgery, Mayo Clinic, Rochester, MN, 55905, USA.
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40
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Kim Y, Cho MH, Do K, Kang HJ, Mok JJ, Kim MK, Kim GS. Incidence and risk factors of urinary tract infections in hospitalised patients with spinal cord injury. J Clin Nurs 2021; 30:2068-2078. [PMID: 33829566 DOI: 10.1111/jocn.15763] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/23/2020] [Accepted: 03/10/2021] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To investigate the incidence of urinary tract infection and analyse its risk factors among hospitalised patients with spinal cord injury. BACKGROUND While the incidence of urinary tract infection varies widely according to the healthcare setting and patients' clinical characteristics, formal reports are limited in quantity. There has been no consensus regarding the risk factors for urinary tract infection. DESIGN A retrospective descriptive study. METHODS Electronic medical records of 964 subjects between 2010-2017 were reviewed. Urinary tract infection status was examined to identify newly occurred cases. Data included demographic and clinical characteristics, hydration status and length of hospitalisation. The reporting of the study followed the EQUATOR Network's STROBE checklist. RESULTS Of the sample, 31.7% had urinary tract infection (95% confidence interval: 1.288 to 1.347, p < .001). Sex, completeness of injury, type of bladder emptying, detrusor function and urethral pressure were significant factors affecting urinary tract infection. Patients who were male and those with injury classifications A, B and C had higher risk of urinary tract infection. Patients with urinary or suprapubic indwelling catheters, as well as those with areflexic detrusor combined with normotonic urethral pressure or overactive detrusor combined with normotonic urethral pressure, showed higher risk. Length of hospitalisation in patients with urinary tract infection was greater than that in uninfected patients, which implies the importance of prevention of urinary tract infection. CONCLUSIONS Nurses should carefully assess risk factors to prevent urinary tract infection in patients with spinal cord injury in the acute and sub-acute stages of the disease trajectory and provide individualised nursing care. RELEVANCE TO CLINICAL PRACTICE This study contributes evidence for up-to-date clinical nursing practice for the comprehensive management of urinary tract infection. This can lead to improvements in nursing care quality and patient outcomes, including length of hospitalisation.
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Affiliation(s)
- Yielin Kim
- Division of Nursing, Severance Hospital, Yonsei University Health System, Seoul, South Korea.,Graduate School, College of Nursing, Yonsei University, Seoul, South Korea
| | - Mi Hwa Cho
- Division of Nursing, Severance Hospital, Yonsei University Health System, Seoul, South Korea
| | - Kyungmin Do
- Division of Nursing, Severance Hospital, Yonsei University Health System, Seoul, South Korea
| | - Hye Jin Kang
- Division of Nursing, Severance Hospital, Yonsei University Health System, Seoul, South Korea
| | - Jin Ju Mok
- Division of Nursing, Severance Hospital, Yonsei University Health System, Seoul, South Korea
| | - Mi Kyoung Kim
- Division of Nursing, Severance Hospital, Yonsei University Health System, Seoul, South Korea
| | - Gwang Suk Kim
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
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Zrzavy T, Schwaiger C, Wimmer I, Berger T, Bauer J, Butovsky O, Schwab JM, Lassmann H, Höftberger R. Acute and non-resolving inflammation associate with oxidative injury after human spinal cord injury. Brain 2021; 144:144-161. [PMID: 33578421 PMCID: PMC7880675 DOI: 10.1093/brain/awaa360] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/08/2020] [Accepted: 08/11/2020] [Indexed: 12/25/2022] Open
Abstract
Traumatic spinal cord injury is a devastating insult followed by progressive cord atrophy and neurodegeneration. Dysregulated or non-resolving inflammatory processes can disturb neuronal homeostasis and drive neurodegeneration. Here, we provide an in-depth characterization of innate and adaptive inflammatory responses as well as oxidative tissue injury in human traumatic spinal cord injury lesions compared to non-traumatic control cords. In the lesion core, microglia were rapidly lost while intermediate (co-expressing pro- as well as anti-inflammatory molecules) blood-borne macrophages dominated. In contrast, in the surrounding rim, TMEM119+ microglia numbers were maintained through local proliferation and demonstrated a predominantly pro-inflammatory phenotype. Lymphocyte numbers were low and mainly consisted of CD8+ T cells. Only in a subpopulation of patients, CD138+/IgG+ plasma cells were detected, which could serve as candidate cellular sources for a developing humoral immunity. Oxidative neuronal cell body and axonal injury was visualized by intracellular accumulation of amyloid precursor protein (APP) and oxidized phospholipids (e06) and occurred early within the lesion core and declined over time. In contrast, within the surrounding rim, pronounced APP+/e06+ axon-dendritic injury of neurons was detected, which remained significantly elevated up to months/years, thus providing mechanistic evidence for ongoing neuronal damage long after initial trauma. Dynamic and sustained neurotoxicity after human spinal cord injury might be a substantial contributor to (i) an impaired response to rehabilitation; (ii) overall failure of recovery; or (iii) late loss of recovered function (neuro-worsening/degeneration).
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Affiliation(s)
- Tobias Zrzavy
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Carmen Schwaiger
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Isabella Wimmer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Jan Bauer
- Center for Brain Research, Medical University of Vienna, Austria
| | - Oleg Butovsky
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Womeńs Hospital, Harvard Medical School, Boston, MA, USA
- Evergrande Center for Immunologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jan M Schwab
- The Belford Center for Spinal Cord Injury, The Ohio State University, Columbus, OH 43210, USA
- Department of Neurology, The Ohio State University, Columbus, OH 43210, USA
- Department of Physical Medicine & Rehabilitation, The Ohio State University, Columbus, OH 43210, USA
- Department of Neuroscience, The Ohio State University, Columbus, OH 43210, USA
| | - Hans Lassmann
- Center for Brain Research, Medical University of Vienna, Austria
| | - Romana Höftberger
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
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Graham ZA, DeBerry JJ, Cardozo CP, Bamman MM. A 50 kdyne contusion spinal cord injury with or without the drug SS-31 was not associated with major changes in muscle mass or gene expression 14 d after injury in young male mice. Physiol Rep 2021; 9:e14751. [PMID: 33611851 PMCID: PMC7897452 DOI: 10.14814/phy2.14751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 12/23/2022] Open
Abstract
Spinal cord injury (SCI) leads to rapid muscle atrophy due to paralysis/paresis and subsequent disuse. SS-31 is a mitochondrial-targeting peptide that has shown efficacy in protecting skeletal muscle mass and function in non-SCI models of muscle wasting. We aimed to determine if SS-31 could prevent muscle loss after SCI. Male C57BL/6 mice aged 9 weeks underwent sham surgery or 50 kdyne contusion SCI and were administered daily injections of vehicle or 5 mg/kg SS-31 for 14 d. Both SCI groups had sustained losses in body mass compared to Sham animals and ~10% reductions in gastrocnemius, plantaris and tibialis anterior muscle mass after SCI with no clear effect of SS-31. Measurements of protein synthesis in the soleus and plantaris were similar among all groups. mRNA expression of atrophy-associated proinflammatory cytokines was also similar among all groups. There was elevation in MYH7 mRNA and a statistical reduction in MYH2 mRNA expression in the SCI+SS-31 animals compared to Sham animals. There was an SCI-induced reduction in mRNA expression of the E3 ligase FBXO32 (MAFbx), but no effect of SS-31. In summary, a 50 kdyne contusion SCI was able to reduce body mass but was not associated with substantial muscle atrophy or alterations in gene expression profiles associated with muscle health and function 14 d post-injury. SS-31 was not associated with protection against SCI-related changes in body or muscle mass, protein synthesis or gene expression in hindlimb muscles.
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Affiliation(s)
- Zachary A. Graham
- Research ServiceBirmingham VA Medical CenterBirminghamALUSA
- Department of Cell, Developmental, and Integrative BiologyUniversity of Alabama‐BirminghamBirminghamALUSA
| | - Jennifer J. DeBerry
- Department of Anesthesiology and Perioperative MedicineUniversity of Alabama‐BirminghamBirminghamALUSA
| | - Christopher P. Cardozo
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical CenterBronxNYUSA
- Medical ServiceJames J. Peters VA Medical CenterBronxNYUSA
- Departments of Medicine and Rehabilitation MedicineIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Marcas M. Bamman
- Research ServiceBirmingham VA Medical CenterBirminghamALUSA
- Department of Cell, Developmental, and Integrative BiologyUniversity of Alabama‐BirminghamBirminghamALUSA
- UAB Center for Exercise MedicineUniversity of Alabama‐BirminghamBirminghamALUSA
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43
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Fouad K, Popovich PG, Kopp MA, Schwab JM. The neuroanatomical-functional paradox in spinal cord injury. Nat Rev Neurol 2021; 17:53-62. [PMID: 33311711 PMCID: PMC9012488 DOI: 10.1038/s41582-020-00436-x] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 12/13/2022]
Abstract
Although lesion size is widely considered to be the most reliable predictor of outcome after CNS injury, lesions of comparable size can produce vastly different magnitudes of functional impairment and subsequent recovery. This neuroanatomical-functional paradox is likely to contribute to the many failed attempts to independently replicate findings from animal models of neurotrauma. In humans, the analogous clinical-radiological paradox could explain why individuals with similar injuries can respond differently to rehabilitation. We describe the neuroanatomical-functional paradox in the context of traumatic spinal cord injury (SCI) and discuss the underlying mechanisms of the paradox, including the concepts of lesion-affected and recovery-related networks. We also consider the various secondary complications that further limit the accuracy of outcome prediction in SCI and provide suggestions for how to increase the predictive, translational value of preclinical SCI models.
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Affiliation(s)
- Karim Fouad
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Institute for Neuroscience and Mental Health, University of Alberta, Edmonton, AB, Canada
| | - Phillip G Popovich
- Belford Center for Spinal Cord Injury, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
- Center for Brain and Spinal Cord Repair, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
- Department of Neuroscience, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
- The Neurological Institute, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Marcel A Kopp
- Clinical & Experimental Spinal Cord Injury Research, Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health (QUEST-Center for Transforming Biomedical Research), Berlin, Germany
| | - Jan M Schwab
- Belford Center for Spinal Cord Injury, The Ohio State University, Wexner Medical Center, Columbus, OH, USA.
- Center for Brain and Spinal Cord Repair, The Ohio State University, Wexner Medical Center, Columbus, OH, USA.
- Department of Neuroscience, The Ohio State University, Wexner Medical Center, Columbus, OH, USA.
- The Neurological Institute, The Ohio State University, Wexner Medical Center, Columbus, OH, USA.
- Clinical & Experimental Spinal Cord Injury Research, Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
- Spinal Cord Injury Medicine (Neuroplegiology), Department of Neurology, The Ohio State University, Wexner Medical Center, Columbus, OH, USA.
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Wexner Medical Center, Columbus, OH, USA.
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Badhiwala JH, Wilson JR, Witiw CD, Harrop JS, Vaccaro AR, Aarabi B, Grossman RG, Geisler FH, Fehlings MG. The influence of timing of surgical decompression for acute spinal cord injury: a pooled analysis of individual patient data. Lancet Neurol 2020; 20:117-126. [PMID: 33357514 DOI: 10.1016/s1474-4422(20)30406-3] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although there is a strong biological rationale for early decompression of the injured spinal cord, the influence of the timing of surgical decompression for acute spinal cord injury (SCI) remains debated, with substantial variability in clinical practice. We aimed to objectively evaluate the effect of timing of decompressive surgery for acute SCI on long-term neurological outcomes. METHODS We did a pooled analysis of individual patient data derived from four independent, prospective, multicentre data sources, including data from December, 1991, to March, 2017. Three of these studies had been published; of these, only one study previously specifically analysed the effect of the timing of surgical decompression. These four datasets were selected because they were among the highest quality acute SCI datasets available and contained highly granular data. Individual patient data were obtained by request from study authors. All patients who underwent decompressive surgery for acute SCI within these datasets were included. Patients were stratified into early (<24 h after spinal injury) and late (≥24 h after spinal injury) decompression groups. Neurological outcomes were assessed by American Spinal Injury Association (ASIA), or International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), examination. The primary endpoint was change in total motor score from baseline to 1 year after spinal injury. Secondary endpoints were ASIA Impairment Scale (AIS) grade and change in upper-extremity motor, lower-extremity motor, light touch, and pin prick scores after 1 year. One-stage meta-analyses were done by hierarchical mixed-effects regression adjusting for baseline score, age, mechanism of injury, AIS grade, level of injury, and administration of methylprednisolone. Effect sizes were summarised by mean difference (MD) for sensorimotor scores and common odds ratio (cOR) for AIS grade, with corresponding 95% CIs. As a secondary analysis, change in total motor score was regressed against time to surgical decompression (h) as a continuous variable, using a restricted cubic spline with adjustment for the same covariates as in the primary analysis. FINDINGS We identified 1548 eligible patients from the four datasets. Outcome data at 1 year after spinal injury were available for 1031 patients (66·6%). Patients who underwent early surgical decompression (n=528) experienced greater recovery than patients who had late decompression surgery (n=1020) at 1 year after spinal injury; total motor scores improved by 23·7 points (95% CI 19·2-28·2) in the early surgery group versus 19·7 points (15·3-24·0) in the late surgery group (MD 4·0 points [1·7-6·3]; p=0·0006), light touch scores improved by 19·0 points (15·1-23·0) vs 14·8 points (11·2-18·4; MD 4·3 [1·6-7·0]; p=0·0021), and pin prick scores improved by 18·3 points (13·7-22·9) versus 14·2 points (9·8-18·6; MD 4·0 [1·5-6·6]; p=0·0020). Patients who had early decompression also had better AIS grades at 1 year after surgery, indicating less severe impairment, compared with patients who had late surgery (cOR 1·48 [95% CI 1·16-1·89]; p=0·0019). When time to surgical decompression was modelled as a continuous variable, there was a steep decline in change in total motor score with increasing time during the first 24-36 h after injury (p<0·0001); and after 36 h, change in total motor score plateaued. INTERPRETATION Surgical decompression within 24 h of acute SCI is associated with improved sensorimotor recovery. The first 24-36 h after injury appears to represent a crucial time window to achieve optimal neurological recovery with decompressive surgery following acute SCI. FUNDING None.
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Affiliation(s)
- Jetan H Badhiwala
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jefferson R Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Christopher D Witiw
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - James S Harrop
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Bizhan Aarabi
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Robert G Grossman
- Department of Neurosurgery, Houston Methodist Hospital, Houston, TX, USA
| | | | - Michael G Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
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Cross-cultural adaptation and psychometric testing of the Thai version of the Spinal Cord Independence Measure III-Self Report. Spinal Cord 2020; 59:291-297. [PMID: 32963364 DOI: 10.1038/s41393-020-00556-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 09/03/2020] [Accepted: 09/11/2020] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Cross-sectional reliability and validation study. OBJECTIVE To translate and assess the psychometric properties of the Thai version of the Spinal Cord Independence Measure III-Self Report (TH-SCIM-SR) in Thai spinal cord injury (SCI) patients. SETTING Faculty of Medicine Siriraj Hospital, Mahidol University. METHODS A cross-cultural forward and backward translation of the original Spinal Cord Independence Measure III-Self Report (SCIM-SR) was performed at the Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand, to create the TH-SCIM-SR. The inclusion criteria were Thai patients with SCI duration of ≥3 months. Patients were evaluated by a team of healthcare professionals using the Thai version of the Spinal Cord Independence Measure Version III (TH-SCIM III). Study patients subsequently completed the TH-SCIM-SR two times with a 3-day interval between evaluations. Cronbach's Alpha, Pearson's correlation coefficient, and intraclass correlation coefficient (ICC) were used to examine internal consistency, concurrent validity, and reliability, respectively. Bland-Altman plot was used to compare scoring results between the TH-SCIM III and the TH-SCIM-SR. RESULTS Thirty-two patients were included. Cronbach's alpha of total score, self-care subscale, respiration/sphincter management, and mobility subscale were 0.91, 0.94, 0.75, and 0.90, respectively. The reliability analysis showed good reliability. The test-retest ICC of total score, self-care subscale, respiration/sphincter management, and mobility subscale were 0.95, 0.95, 0.78, and 0.96, respectively. Regarding construct validity, the subscales of TH-SCIM-SR demonstrated a strong correlation with those of the TH-SCIM III (0.85-0.96). CONCLUSIONS TH-SCIM-SR showed good reliability and validity for assessing functional independence in Thai patients with SCI.
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Gillespie ER, Ruitenberg MJ. Neuroinflammation after SCI: Current Insights and Therapeutic Potential of Intravenous Immunoglobulin. J Neurotrauma 2020; 39:320-332. [PMID: 32689880 DOI: 10.1089/neu.2019.6952] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Traumatic spinal cord injury (SCI) elicits a complex cascade of cellular and molecular inflammatory events. Although certain aspects of the inflammatory response are essential to wound healing and repair, post-SCI inflammation is, on balance, thought to be detrimental to recovery by causing "bystander damage" and the spread of pathology into spared but vulnerable regions of the spinal cord. Much of the research to date has therefore focused on understanding the inflammatory drivers of secondary tissue loss after SCI, to define therapeutic targets and positively modulate this response. Numerous experimental studies have demonstrated that modulation of the inflammatory response to SCI can indeed lead to significant neuroprotection and improved recovery. However, it is now also recognized that broadscale immunosuppression is not necessarily beneficial and may even carry the risk of contributing to the development of serious adverse events. Immune modulation rather than suppression is therefore now considered a more promising approach to target harmful post-traumatic inflammation following a major neurotraumatic event such as SCI. One promising immunomodulatory agent is intravenous immunoglobulin (IVIG), a plasma product that contains mostly immunoglobulin G (IgG) from thousands of healthy donors. IVIG is currently already widely used to treat a range of autoimmune diseases, but recent studies have found that it also holds great promise for treating acute neurological conditions, including SCI. This review provides an overview of the inflammatory response to SCI, immunomodulatory approaches that are currently in clinical trials, proposed mechanisms of action for IVIG therapy, and the putative relevance of these in the context of neurotraumatic events.
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Affiliation(s)
- Ellen R Gillespie
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Marc J Ruitenberg
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Trauma, Critical Care, and Recovery, Brisbane Diamantina Health Partners, Brisbane, Australia
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Peña Pino I, Hoover C, Venkatesh S, Ahmadi A, Sturtevant D, Patrick N, Freeman D, Parr A, Samadani U, Balser D, Krassioukov A, Phillips A, Netoff TI, Darrow D. Long-Term Spinal Cord Stimulation After Chronic Complete Spinal Cord Injury Enables Volitional Movement in the Absence of Stimulation. Front Syst Neurosci 2020; 14:35. [PMID: 32714156 PMCID: PMC7340010 DOI: 10.3389/fnsys.2020.00035] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 05/18/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Chronic spinal cord injury (SCI) portends a low probability of recovery, especially in the most severe subset of motor-complete injuries. Active spinal cord stimulation with or without intensive locomotor training has been reported to restore movement after traumatic SCI. Only three cases have been reported where participants developed restored volitional movement with active stimulation turned off after a period of chronic stimulation and only after intensive rehabilitation with locomotor training. It is unknown whether restoration of movement without stimulation is possible after stimulation alone. Objective: We describe the development of spontaneous volitional movement (SVM) without active stimulation in a subset of participants in the Epidural Stimulation After Neurologic Damage (ESTAND) trial, in which locomotor training is not prescribed as part of the study protocol, and subject’s rehabilitation therapies are not modified. Methods: Volitional movement was evaluated with the Brain Motor Control Assessment using sEMG recordings and visual examination at baseline and at follow-up visits with and without stimulation. Additional functional assessment with a motor-assisted bicycle exercise at follow-up with and without stimulation identified generated work with and without effort. Results: The first seven participants had ASIA Impairment Scale (AIS) A or B thoracic SCI, a mean age of 42 years, and 7.7 years post-injury on average. Four patients developed evidence of sustained volitional movement, even in the absence of active stimulation after undergoing chronic epidural spinal cord stimulation (eSCS). Significant increases in volitional power were found between those observed to spontaneously move without stimulation and those unable (p < 0.0005). The likelihood of recovery of spontaneous volitional control was correlated with spasticity scores prior to the start of eSCS therapy (p = 0.048). Volitional power progressively improved over time (p = 0.016). Additionally, cycling was possible without stimulation (p < 0.005). Conclusion: While some SVM after eSCS has been reported in the literature, this study demonstrates sustained restoration without active stimulation after long-term eSCS stimulation in chronic and complete SCI in a subset of participants. This finding supports previous studies suggesting that “complete” SCI is likely not as common as previously believed, if it exists at all in the absence of transection and that preserved pathways are substrates for eSCS-mediated recovery in clinically motor-complete SCI. Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT03026816.
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Affiliation(s)
- Isabela Peña Pino
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States
| | - Caleb Hoover
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, United States
| | - Shivani Venkatesh
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, United States
| | - Aliya Ahmadi
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, United States
| | - Dylan Sturtevant
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, United States
| | - Nick Patrick
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States
| | - David Freeman
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, United States
| | - Ann Parr
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, United States
| | - Uzma Samadani
- Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, MN, United States.,Division of Neurosurgery, VA Healthcare System, Minneapolis, MN, United States
| | - David Balser
- International Collaboration on Repair Discoveries, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada
| | - Andrei Krassioukov
- International Collaboration on Repair Discoveries, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada
| | - Aaron Phillips
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Theoden I Netoff
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States
| | - David Darrow
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, United States.,Division of Neurosurgery, Hennepin County Medical Center, Minneapolis, MN, United States
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ter Wengel PV, De Haan Y, Feller RE, Oner FC, Vandertop WP. Complete Traumatic Spinal Cord Injury: Current Insights Regarding Timing of Surgery and Level of Injury. Global Spine J 2020; 10:324-331. [PMID: 32313798 PMCID: PMC7160809 DOI: 10.1177/2192568219844990] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
STUDY DESIGN A narrative literature review. OBJECTIVES To review the neurological recovery patterns in traumatic spinal cord injury (tSCI) patients with a complete lack of motor and sensory function below the level of injury (ie, ASIA A [American Spinal Injury Association scale]), as well as the impact of level of injury and timing of surgical intervention. RESULTS Spontaneous neurological recovery in patients with complete tSCI differs per level of injury: patients with cervical and thoracolumbar tSCI recover ≥1 ASIA grade in 17.3% to 34.0% 1 year after injury, compared with 10.7% to 18.6% in thoracic tSCI. Surgical decompression within 24 hours has a beneficial effect on neurological recovery in patients with complete cervical tSCI, whereas this effect is less clear for thoracic and thoracolumbar tSCI. A 1- or 2-grade improvement in the ASIA scale does not necessarily result in functional recovery. CONCLUSION In complete tSCI, the level of injury as well as surgical timing affect neurological recovery. There appears to be a beneficial effect of early surgical decompression in patients with complete cervical tSCI, more so than for thoracic and thoracolumbar tSCI. Frequently, the effect of surgical intervention is evaluated by an improvement in ASIA grade, but it is unclear whether this scale is sensitive enough to evaluate meaningful effectiveness of the intervention and desired outcome for patients with tSCI.
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Affiliation(s)
- Paula Valerie ter Wengel
- VU University Medical Center, Amsterdam, Netherlands,Leiden University Medical Center, Leiden, Netherlands,Paula Valerie ter Wengel, De Boelelaan 1117,
Amsterdam 1081 HV, Netherlands.
| | | | | | | | - William Peter Vandertop
- VU University Medical Center, Amsterdam, Netherlands,Academic Medical Center, Amsterdam, Netherlands
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Dumlao PIE, Grozman S. Neurological recovery after surgical intervention of a complete spinal cord injury secondary to a chronic untreated odontoid neck fracture: a lesson in patient prognostication. BMJ Case Rep 2020; 13:13/1/e233077. [PMID: 31937631 DOI: 10.1136/bcr-2019-233077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Odontoid fractures are injuries that can either be benign or devastatingly progress to quadriplegia and significant morbidity and mortality. Management is not clear cut for patients who already present late and with severe neurological deficits. We present a case of a type 2 odontoid fracture with associated complete spinal cord injury (American Spinal Injury Association A) initially untreated for 3 months but was subsequently managed with posterior decompression, instrumentation and occipitocervical fusion. The patient fully recovered all deficits and is independent of activities of daily living.
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Affiliation(s)
| | - Samuel Grozman
- Orthopedics, University of the Philippines Manila, Ermita, Manila, Metro Manila, Philippines
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