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Ariji Y, Hayashi T, Ideta R, Koga R, Murai S, Naka T, Ifuku R, Towatari F, Sakai H, Kurata H, Maeda T. Identification of a reliable sacral-sparing examination to assess the ASIA impairment scale in patients with traumatic spinal cord injury. J Spinal Cord Med 2024; 47:286-292. [PMID: 35352975 PMCID: PMC10885764 DOI: 10.1080/10790268.2022.2047548] [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: 10/18/2022] Open
Abstract
OBJECTIVES We evaluated the time course of the American Spinal Cord Injury Association (ASIA) impairment scale (AIS) for up to three months in participants within 72 h after traumatic spinal cord injury (TSCI) with complete paralysis. We aimed to determine the most useful sacral-sparing examination (deep anal pressure [DAP], voluntary anal contraction [VAC], S4-5 light touch [LT], or pin prick [PP] sensation) in determining AIS grades. DESIGN Retrospective cohort study. SETTING Spinal Injuries Center, Fukuoka, Japan. PARTICIPANTS Among 668 TSCI participants registered in the Japan Single Center study for Spinal Cord Injury Database (JSSCI-DB) between January 2012 and May 2020, we extracted the data of 80 patients with AIS grade A within 72 h after injury and neurological level of injury (NLI) at T12 or higher. INTERVENTIONS None. OUTCOME MEASURES The sacral-sparing examination at the time of the change to incomplete paralysis was compared to the AIS determination using a standard algorithm and with each assessment including the VAC, DAP, S4-5LT, and S4-5PP examinations at the time of AIS functional change. Agreement among assessments was evaluated using weighted kappa coefficients. The relationship was evaluated using Spearman's rank correlation coefficients. RESULTS Fifteen participants (18.8%) improved to incomplete paralysis (AIS B to D) within three months after injury. The single assessment among the sacral-sparing examinations with the highest agreement and strongest correlation with AIS determination was the S4-5LT examination (k = 0.89, P < 0.01, r = 0.84, P < 0.01). CONCLUSIONS The S4-5LT examination is key in determining complete or incomplete paralysis due to its high discriminatory power.
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Affiliation(s)
- Yuto Ariji
- Department of Rehabilitation Medicine, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
| | - Tetsuo Hayashi
- Department of Rehabilitation Medicine, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
- Department of Orthopedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
| | - Ryosuke Ideta
- Department of Rehabilitation Medicine, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
| | - Ryuichiro Koga
- Department of Rehabilitation Medicine, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
| | - Satoshi Murai
- Department of Rehabilitation Medicine, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
| | - Tomoki Naka
- Department of Rehabilitation Medicine, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
| | - Ryusei Ifuku
- Department of Rehabilitation Medicine, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
| | - Fumihiro Towatari
- Department of Rehabilitation Medicine, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
| | - Hiroaki Sakai
- Department of Orthopedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
| | - Hiroyuki Kurata
- Department of Bioscience and Bioinformatics, Kyushu Institute of Technology - Iizuka Campus, Fukuoka, Japan
| | - Takeshi Maeda
- Department of Orthopedic Surgery, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Fukuoka, Japan
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Tsuji O, Suda K, Michikawa T, Takahata M, Ozaki M, Konomi T, Matsumoto Harmon S, Komatsu M, Ushiku C, Menjo Y, Iimoto S, Watanabe K, Nakamura M, Matsumoto M, Minami A, Iwasaki N. Risk factors of AIS C incomplete cervical spinal cord injury for poor prognosis-The significance of anorectal evaluation. J Orthop Sci 2023; 28:1227-1233. [PMID: 36334964 DOI: 10.1016/j.jos.2022.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 09/28/2022] [Accepted: 10/14/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although the prognosis of incomplete cervical spinal cord injury (SCI) diagnosed as American Spinal Injury Association Impairment Scale grade C (AIS C) is generally favorable, some patients remain non-ambulatory. The present study explored the clinical factors associated with the non-ambulatory state of AIS C patients. METHODS This study was a single-center retrospective observational study. Seventy-three participants with AIS C on admission were enrolled and divided into two groups according to ambulatory ability after one year. Prognostic factors of SCI were compared in ambulatory (A-group) and non-ambulatory participants (NA-group). Univariable and multivariable logistic regression analyses were performed on demographic information, medical history, mechanism of injury, presence of fracture, ASIA motor scores (MS) of the extremities, neurological findings, including an anorectal examination on admission, and imaging findings. RESULTS Forty-one patients were included in the A-group and 32 in the NA-group. Univariable analysis revealed that the following factors were related to poor outcomes (p < 0.05): older age, history of cerebrovascular disorder, impairment/absence of S4-5 sensory score, deep anal pressure (DAP) (-), voluntary anal contraction (VAC) (-), anorectal tone (-), anal wink reflex (-), and low MS of the upper and lower extremities. In the multivariable analysis using age, presence or absence of sacral abnormality, and history of cerebrovascular disorders (adjusted for these three factors), older age and presence of sacral abnormality on admission were independent risk factors for a non-ambulatory state at the 1-year follow-up. CONCLUSIONS Incomplete AIS C SCI individuals with older age and/or impairment of anorectal examination could remain non-ambulatory at 1-year follow-up.
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Affiliation(s)
- Osahiko Tsuji
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, 3-1 Higashi 4 Minami 1, Bibai, Hokkaido, 072-0015, Japan; Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
| | - Kota Suda
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, 3-1 Higashi 4 Minami 1, Bibai, Hokkaido, 072-0015, Japan.
| | - Takehiro Michikawa
- Department of Environmental and Occupational Health, School of Medicine, Toho University, 5-21-16 Omori-nishi, Ota-ku, Tokyo, 143-8540, Japan.
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, 060-8638, Japan.
| | - Masahiro Ozaki
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, 3-1 Higashi 4 Minami 1, Bibai, Hokkaido, 072-0015, Japan; Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
| | - Tsunehiko Konomi
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, 3-1 Higashi 4 Minami 1, Bibai, Hokkaido, 072-0015, Japan; Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
| | - Satoko Matsumoto Harmon
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, 3-1 Higashi 4 Minami 1, Bibai, Hokkaido, 072-0015, Japan.
| | - Miki Komatsu
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, 3-1 Higashi 4 Minami 1, Bibai, Hokkaido, 072-0015, Japan.
| | - Chikara Ushiku
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, 3-1 Higashi 4 Minami 1, Bibai, Hokkaido, 072-0015, Japan.
| | - Yusuke Menjo
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, 3-1 Higashi 4 Minami 1, Bibai, Hokkaido, 072-0015, Japan.
| | - Seiji Iimoto
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, 3-1 Higashi 4 Minami 1, Bibai, Hokkaido, 072-0015, Japan.
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
| | - Akio Minami
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, 3-1 Higashi 4 Minami 1, Bibai, Hokkaido, 072-0015, Japan.
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, 060-8638, Japan.
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Furbish CL, Anderson RK, Field-Fote EC. Accuracy of self-reported severity and level of spinal cord injury. Spinal Cord 2022; 60:934-941. [PMID: 36097066 PMCID: PMC9464614 DOI: 10.1038/s41393-022-00855-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 11/09/2022]
Abstract
Study design Observational. Objectives To assess accuracy of self-reported level of injury (LOI) and severity in individuals with chronic spinal cord injury (SCI) as compared with clinical examination. Setting An SCI Model System Hospital. Methods A 20-item survey evaluated demographics, physical abilities, and self-reported injury level and severity. A decision tree algorithm used responses to categorize participants into injury severity groups. Following the survey, participants underwent clinical examination to determine current injury level and severity. Participants were later asked three questions regarding S1 sparing. Chart abstraction was utilized to obtain initial injury level and severity. Injury level and severity from self-report, decision tree, clinical exam, and chart abstraction were compared. Results Twenty-eight individuals participated. Ninety-three percent correctly self-reported anatomical region of injury (ROI). Self-report of specific LOI matched current clinical LOI for 25% of participants, but matched initial LOI for 61%. Self-report of ASIA Impairment Scale (AIS) matched clinical AIS for 36%, but matched initial AIS for 46%. The injury severity decision tree was 75% accurate without, but 79% accurate with additional S1 questions. Self-report of deep anal pressure (DAP) was correct for 86% of participants, while self-report of voluntary anal contraction (VAC) was correct for 82%. Conclusion Individuals with SCI are more accurate reporting ROI than specific LOI. Self-reported injury level and severity align more closely with initial clinical examination results than current exam results. Using aggregate data from multiple questions can categorize injury severity more reliably than self-report. Using this type of decision tree may improve injury severity classification in large survey studies.
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Pathophysiology, Classification and Comorbidities after Traumatic Spinal Cord Injury. J Pers Med 2022; 12:jpm12071126. [PMID: 35887623 PMCID: PMC9323191 DOI: 10.3390/jpm12071126] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/26/2022] [Accepted: 06/27/2022] [Indexed: 12/25/2022] Open
Abstract
The spinal cord is a conduit within the central nervous system (CNS) that provides ongoing communication between the brain and the rest of the body, conveying complex sensory and motor information necessary for safety, movement, reflexes, and optimization of autonomic function. After a spinal cord injury (SCI), supraspinal influences on the spinal segmental control system and autonomic nervous system (ANS) are disrupted, leading to spastic paralysis, pain and dysesthesia, sympathetic blunting and parasympathetic dominance resulting in cardiac dysrhythmias, systemic hypotension, bronchoconstriction, copious respiratory secretions and uncontrolled bowel, bladder, and sexual dysfunction. This article outlines the pathophysiology of traumatic SCI, current and emerging methods of classification, and its influence on sensory/motor function, and introduces the probable comorbidities associated with SCI that will be discussed in more detail in the accompanying manuscripts of this special issue.
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Romanini F, Lima TDS, Abou L, Ilha J. Adaptação transcultural para o Português do questionário de autorrelato da função sensorial e motora de S4-5 (S4-5Q) em pessoas com lesão medular espinhal. Rev Bras Ortop 2022; 57:384-391. [PMID: 35785125 PMCID: PMC9246521 DOI: 10.1055/s-0041-1735233] [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] [Received: 02/22/2021] [Accepted: 03/08/2021] [Indexed: 11/21/2022] Open
Abstract
Objective
The “Self-report S4-5 sensory and motor function questionnaire (S4-5Q)” is a short questionnaire that aims to assess the function of the sacral segments, S4 and S5, after a spinal cord injury (SCI), with the purpose of replacing the rectal exam test. The aim of the present study was to carry out a cross-cultural adaptation of the S4-5Q to the Brazilian Portuguese language and to investigate the test-retest reliability of this version.
Method
The translation and cross-cultural adaptation was performed using the methodology of translation and backtranslation. Initially, translations were done by three independent translators. Their synthesis was then submitted to an expert committee for analysis (SCI health professionals); then, the backtranslation to the original language was sent to the original author and, after all the adjustments, the final version was completed. For test-retest reliability, 24 individuals with chronic SCI were recruited (2 evaluations with an interval of 7 to 14 days between them). Statistical analysis was performed using IBM-SPSS (Version 20, SPSS Inc, Chicago, IL, USA) with data pretabulated in Microsoft Excel (Microsoft Corporation, Redmond, WA, USA). Reliability was tested with Cohen Kappa, and internal consistency with Cronbach α, both adopting
p
< 0.05 as significant.
Results
In the reliability analysis, the results of all questions showed almost perfect agreement (Kappa > 0.81) and good internal consistency (Cronbach α: 0.65–0.77) between the questions and final classification.
Conclusion
The cross-culturally adapted S4-5Q is reliable to be applied to the Brazilian population with chronic SCI to determine their S4-5 sensory and motor function.
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Affiliation(s)
- Francielle Romanini
- Núcleo de Pesquisa em Lesão Medular, Universidade do Estado de Santa Catarina, Programa de Pós-Graduação em Neurociência, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
| | - Thays de Souza Lima
- Núcleo de Pesquisa em Lesão Medular, Universidade do Estado de Santa Catarina, Florianópolis, SC, Brasil
| | - Libak Abou
- Departamento de Cinesiologia e Saúde Comunitária, Faculdade de Ciências Aplicadas à Saúde, Universidade de Illinois em Urbana-Champaign, Urbana, Illinois, Estados Unidos
| | - Jocemar Ilha
- Núcleo de Pesquisa em Lesão Medular, Universidade do Estado de Santa Catarina, Programa de Pós-Graduação em Neurociência, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
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Sánchez JAS, Sharif S, Costa F, Rangel JAIR, Anania CD, Zileli M. Early Management of Spinal Cord Injury: WFNS Spine Committee Recommendations. Neurospine 2020; 17:759-784. [PMID: 33401855 PMCID: PMC7788427 DOI: 10.14245/ns.2040366.183] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 09/14/2020] [Accepted: 10/11/2020] [Indexed: 12/29/2022] Open
Abstract
Scientific knowledge today is being generated more rapidly than we can assimilate thus requiring continuous review of gold-standards for diagnosis and treatment of specific pathologies. The aim of this paper is to provide an update on the best early management of spinal cord injury (SCI), in order to produce acceptable worldwide recommendations to standardize clinical practice as much as possible.The WFNS Spine Committee voted recommendations regarding management of SCI based on literature review of the last 10 years. The committee stated 9 recommendations on 3 main topics: (1) clinical assessment and classification of SCI; (2) emergency care and early management; (3) cardiopulmonary management. American Spinal Injury Association impairment scale, Spinal Cord Independence Measure, and International Spinal Cord Injury Basic Pain Data Set are considered the most useful and feasible in emergency evaluation and follow-up in case of SCI. Magnetic resonance imaging is the most indicated examination to evaluate patients with symptomatic SCI. In early phase, correction of hypotension (systolic blood pressure < 90 mmHg), and bradycardia are strongly recommended. Surgical decompression should be performed as soon as possible with the ideal surgical time being within 8 hours for both complete and incomplete lesions.
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Affiliation(s)
| | - Salman Sharif
- Department of Neurosurgery, Liaquat National Hospital & Medical College, Karachi, Pakistan
| | - Francesco Costa
- Department of Neurosurgery, Humanitas Clinical and Research Center – IRCCS, Rozzano, Italy
| | | | - Carla Daniela Anania
- Department of Neurosurgery, Humanitas Clinical and Research Center – IRCCS, Rozzano, Italy
| | - Mehmet Zileli
- Department of Neurosurgery, Ege University, Izmir, Turkey
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Kirshblum S, Botticello A, Benedetto J, Donovan J, Marino R, Hsieh S, Wagaman N. A Comparison of Diagnostic Stability of the ASIA Impairment Scale Versus Frankel Classification Systems for Traumatic Spinal Cord Injury. Arch Phys Med Rehabil 2020; 101:1556-1562. [DOI: 10.1016/j.apmr.2020.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/20/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
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Marino RJ, Schmidt-Read M, Chen A, Kirshblum SC, Dyson-Hudson TA, Field-Fote E, Zafonte R. Reliability of S3 pressure sensation and voluntary hip adduction/toe flexion and agreement with deep anal pressure and voluntary anal contraction in classifying persons with traumatic spinal cord injury. J Spinal Cord Med 2020; 43:616-622. [PMID: 31204908 PMCID: PMC7534209 DOI: 10.1080/10790268.2019.1628496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Context/Objective: The sacral examination components of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), namely deep anal pressure (DAP) and voluntary anal sphincter contraction (VAC), are often difficult to perform. We evaluated whether pressure sensation at the S3 dermatome (S3P), and voluntary hip adductor or toe flexor contraction (VHTC) are tenable alternatives. Here we report test-retest reliability and agreement of these components at 1 month after spinal cord injury (SCI), and impact of disagreement on American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades. Design: Longitudinal cohort. ISNCSCI examination, S3P and VHTC conducted at 1-month post-injury; retest of the sacral exam, S3P and VHTC within 3 days. Follow-up examinations performed at 3, 6, and 12 months. Setting: Five Spinal Cord Injury Model System Centers. Participants: Subjects with acute traumatic SCI, neurological levels T12 and above, AIS grades A-C. Interventions: None. Outcome Measures: ISNCSCI exam, AIS grades. Results: Fifty-one subjects had 1-month data, and 39 had at least one follow-up examination. Test-retest reliability indicated perfect agreement (kappa = 1.0) for all data except S3P (kappa = 0.96). The agreement was almost perfect between S3P and DAP (kappa = 0.84) and between VHTC and VAC (kappa = 0.81). VHTC and VAC differed more often with neurologic levels below T10, possibly due to root escape in conus medullaris injuries. Conclusion: S3P and VHTC show promise as alternatives to DAP and VAC for determining sacral sparing in persons with neurologic levels T10 and above. Reliability and agreement should be evaluated at earlier timepoints and in children with SCI.
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Affiliation(s)
- Ralph J. Marino
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA,Correspondence to: Ralph J. Marino, Department of Rehabilitation Medicine, Sidney Kimmel Medical College, 132 South 10th Street, Suite 375 Main Building, Philadelphia, PA19107, USA; Ph: 215-955-5756.
| | | | - Anna Chen
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Steven C. Kirshblum
- Kessler Institute for Rehabilitation, West Orange, New Jersey, USA,Rutgers NJ Medical School, Newark, New Jersey, USA
| | - Trevor A. Dyson-Hudson
- Rutgers NJ Medical School, Newark, New Jersey, USA,Kessler Foundation, West Orange, New Jersey, USA
| | | | - Ross Zafonte
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA,Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA,Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Awad A, Levi R, Waller M, Westling G, Lindgren L, Eriksson J. Preserved somatosensory conduction in complete spinal cord injury: Discomplete SCI. Clin Neurophysiol 2020; 131:1059-1067. [PMID: 32197128 DOI: 10.1016/j.clinph.2020.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/07/2019] [Accepted: 01/07/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Spinal cord injury (SCI) disrupts the communication between brain and body parts innervated from below-injury spinal segments, but rarely results in complete anatomical transection of the spinal cord. The aim of this study was to investigate residual somatosensory conduction in clinically complete SCI, to corroborate the concept of sensory discomplete SCI. METHODS We used fMRI with a somatosensory protocol in which blinded and randomized tactile and nociceptive stimulation was applied on both legs (below-injury level) and one arm (above-injury level) in eleven participants with chronic complete SCI. The experimental design accounts for possible confounding mechanical (e.g. vibration) and cortico-cortical top-down mechanisms (e.g. attention/expectation). RESULTS Somatosensory stimulation on below-level insensate body regions activated the somatotopically corresponding part of the contralateral primary somatosensory cortex in six out of eleven participants. CONCLUSIONS Our results represent afferent-driven cortical activation through preserved somatosensory connections to the brain in a subgroup of participants with clinically complete SCI, i.e. sensory discomplete SCI. SIGNIFICANCE Identifying patients with residual somatosensory connections might open the door for new rehabilitative and restorative strategies as well as inform research on SCI-related conditions such as neuropathic pain and spasticity.
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Affiliation(s)
- Amar Awad
- Umeå Center for Functional Brain Imaging (UFBI), Umeå University, Sweden; Department of Integrative Medical Biology (IMB), Physiology Section, Umeå University, Sweden.
| | - Richard Levi
- Department of Rehabilitation Medicine in Linköping, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Mikael Waller
- Rehabilitation Medicine Clinic, Sunderby Hospital, Region Norrbotten, Sweden.
| | - Göran Westling
- Department of Integrative Medical Biology (IMB), Physiology Section, Umeå University, Sweden.
| | - Lenita Lindgren
- Umeå Center for Functional Brain Imaging (UFBI), Umeå University, Sweden; Department of Nursing, Umeå University, Sweden.
| | - Johan Eriksson
- Umeå Center for Functional Brain Imaging (UFBI), Umeå University, Sweden; Department of Integrative Medical Biology (IMB), Physiology Section, Umeå University, Sweden.
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Alexander M, Carr C, Alexander J, Chen Y, McLain A. Assessing the ability of the Sacral Autonomic Standards to document bladder and bowel function based upon the Asia Impairment Scale. Spinal Cord Ser Cases 2019; 5:85. [PMID: 31700683 PMCID: PMC6821794 DOI: 10.1038/s41394-019-0228-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/14/2019] [Accepted: 09/17/2019] [Indexed: 12/30/2022] Open
Abstract
Study design Retrospective review of data. Objective To determine if there is a relationship between the Asia Impairment Scale (AIS) and the bladder and bowel components of the International Standards to Document Remaining Autonomic Function after SCI (ISAFSCI). Setting University-Based Academic Rehabilitation Program. Methods Retrospective cross-sectional study assessing International Standards for Neurologic Classification After SCI (ISNCSCI) examination along with bladder and bowel components of the ISAFSCI. Results Subjects with AIS A injuries were statistically less likely to have history of bladder control and bowel control per investigator determination and bladder sensation via self-report versus patients categorized with AIS B injuries. Self-reported history of bowel sensation and control of voiding were more likely in subjects with C, D, or E injuries than with B injuries. Bowel and bladder control as determined by investigator and bladder and bowel sensation and control as self-reported were all statistically less likely in persons with AIS A injuries versus CDE. Conclusions This retrospective study provides initial data regarding components of the bladder and bowel sections of the sacral ISAFSCI and AIS. Further prospective research is needed to further characterize the relationship between retention of bladder and bowel sensation and function and the AIS. We suggest that incorporation of the sacral components of the ISAFSCI into the ISNCSCI may be beneficial to obtain further information about retention of sacral function with specific patterns of injury.
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Affiliation(s)
- Marca Alexander
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham School of Medicine, Birmingham, AL USA
| | - Conley Carr
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham School of Medicine, Birmingham, AL USA
| | | | - Yuying Chen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham School of Medicine, Birmingham, AL USA
| | - Amie McLain
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham School of Medicine, Birmingham, AL USA
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Tomaschek R, Gemperli A, Rupp R, Geng V, Scheel-Sailer A. A systematic review of outcome measures in initial rehabilitation of individuals with newly acquired spinal cord injury: providing evidence for clinical practice guidelines. Eur J Phys Rehabil Med 2019; 55:605-617. [DOI: 10.23736/s1973-9087.19.05676-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Hamilton R, Kirshblum S, Sikka S, Callender L, Bennett M, Prajapati P. Sacral examination in spinal cord injury: Is it really needed? J Spinal Cord Med 2018; 41:556-561. [PMID: 29376770 PMCID: PMC6117574 DOI: 10.1080/10790268.2017.1410307] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To determine if a self-report measure of S4-5 motor and sensory function in patients with chronic SCI accurately predicts sacral examination results. DESIGN Prospective, single-blinded self-report survey compared with sacral exam. SETTING Outpatient SCI clinic. PARTICIPANTS 116 patients aged 18+ with chronic SCI > 6 months who have undergone sacral exam. INTERVENTIONS The survey included demographic/clinical and sacral function information such as light tough (LT), pinprick sensation (PP), deep anal pressure (DAP) and voluntary anal contraction (VAC). Survey results and sacral exam were compared and stratified by the patient's American Spinal Cord Injury Association Impairment Scale (AIS) category. OUTCOME MEASURES Sacral self-report survey, AIS examination. RESULTS Mean age was 41.3 ± 14.4 years with majority male (69%) and Caucasian (71.6%). Overall, Positive Predictive Value (PPV) ranged between 48% (VAC) to 73% (DAP) and Negative Predictive Value (NPV) between 92% (VAC) to 100% (LT). AIS-A had NPV of 100% across all categories, and AIS-D had PPV of 100% across all categories. CONCLUSION Patient report of sacral sparing can predict negative sensation in patients with AIS-A and predict positive sensation in persons with AIS-D. Overall, the self-report of sacral sparing of motor and sensory function is not predictive enough to rely on for accurate classification.
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Affiliation(s)
- Rita Hamilton
- Baylor Institute for Rehabilitation, Dallas, Texas, USA,Baylor University Medical Center, Dallas, Texas, USA,Correspondence to: Rita Hamilton, 909 North Washington Avenue, Dallas, TX75246, USA; Ph: 214-820-9593.
| | - Steven Kirshblum
- Kessler Institute for Rehabilitation, West Orange, New Jersey, USA,Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Seema Sikka
- Baylor Institute for Rehabilitation, Dallas, Texas, USA,Baylor University Medical Center, Dallas, Texas, USA
| | - Librada Callender
- Baylor Institute for Rehabilitation, Dallas, Texas, USA,Baylor University Medical Center, Dallas, Texas, USA
| | - Monica Bennett
- Baylor Institute for Rehabilitation, Dallas, Texas, USA,Center for Clinical Effectiveness, Baylor Scott and White Health, Dallas, Texas, USA
| | - Purvi Prajapati
- Center for Clinical Effectiveness, Baylor Scott and White Health, Dallas, Texas, USA
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The anorectal exam is unnecessary! Spinal Cord Ser Cases 2018; 4:3. [PMID: 29423308 DOI: 10.1038/s41394-017-0013-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 09/25/2017] [Indexed: 11/08/2022] Open
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Alexander M, Wecht J, Krassioukov A. Pulse article: Survey on the current usage of the International Standards for the Assessment of Autonomic Function after Spinal Cord Injury (ISAFSCI). Spinal Cord Ser Cases 2017; 3:17100. [PMID: 29423303 DOI: 10.1038/s41394-017-0025-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 09/27/2017] [Accepted: 10/03/2017] [Indexed: 11/09/2022] Open
Abstract
Study design Online questionnaire. Objectives To identify the awareness, and current use, of the International Standards for the Assessment of Autonomic Function after SCI (ISAFSCI) and suggest necessary revisions. Setting An international collaboration of committee members. Methods A survey was drafted and consensus achieved among members of the International Standards Committee of the ASIA. The questionnaire was posted on SurveyMonkey for 2 months. A survey link was posted on the ASIA and ISCoS websites, and committee members circulated the survey to colleagues with the goal of obtaining a wide-spread international response. Results A total of 173 providers responded. About half (n = 84) of the respondents used the standards in some form. Forty-four percent (n = 72) felt they knew the difference between the standards and the data sets. Among 135 responses on the usefulness of the ISAFSCI, the bladder, bowel, and sexual function sections, and the heart rate, respiratory rate, blood pressure, and sudomotor sections for use in patients with tetraplegia were reported as most useful. Comments revealed that respondents would like more explanation regarding specific definitions of components of the standards, how/when to use the ISAFSCI, and how the ISAFSCI may assist in clinical care. Conclusion The ISAFSCI is used by a subset of SCI clinicians. Some find the standards useful, while others are unaware of the utility of the ISAFSCI to prevent morbidity and assist in documentation of autonomic recovery post SCI. Further clarification regarding the definition of various disorders, and how and why to use the ISAFSCI in the SCI population, is needed.
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Affiliation(s)
- Marcalee Alexander
- 1Birmingham VA Medical Center, Birmingham, AL 35233 USA.,2University of Alabama at Birmingham Department of Physical Medicine and Rehabilitation, Birmingham, AL 35294 USA.,3Harvard Medical School Department of Physical Medicine and Rehabilitation, Boston, MA 02115 USA
| | - Jill Wecht
- 4National Center for the Medical Consequences of SCI: James J Peters VA Medical Center, Bronx, NY 10468 USA.,5Department of Medicine and Rehabilitation Medicine, The Icahn School of Medicine, Mount Sinai, New York, NY 10029 USA
| | - Andrei Krassioukov
- 6International Collaboration On Repair Discoveries, Vancouver, BC V6T 1Z4 Canada.,7University of British Columbia, Vancouver, BC V6T 1Z4 Canada
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Alexander M, Aslam H, Marino RJ. Pulse article: How do you do the international standards for neurological classification of SCI anorectal exam? Spinal Cord Ser Cases 2017; 3:17078. [PMID: 29423284 PMCID: PMC5798917 DOI: 10.1038/s41394-017-0015-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/13/2017] [Accepted: 09/18/2017] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Online survey of spinal cord injury (SCI) practitioners. OBJECTIVES Determine provider understanding and routine performance of International Standards for Neurologic Classification of Spinal Cord Injury (ISNCSCI) anorectal examination. SETTING International online questionnaire. METHODS A descriptive survey was developed to assess current performance of the ISNCSCI anorectal exam. Information about this survey was disseminated through social email and international societies between the months of March and April 2017. RESULTS Two hundred and fifteen SCI practitioners completed the survey. Of these, 157 (73%) were specialists in physical medicine and rehabilitation, 32 (15%) were physical therapists, 6 were neurologists, 6 were orthopedists, and 3 were neurosurgeons. Of responders, 90% routinely personally performed the anal exam of the ISNCSCI, of whom, 42 placed firm pressure against the anal sphincter, 58 placed firm pressure against the rectal wall, and 87 placed firm pressure against the anal sphincter and rectal wall as part of the exam. On a routine basis, 74% tested sensation at the junction of the anal sphincter and skin, 82% had the patient attempt to squeeze their finger, and 50% performed the bulbocavernosus reflex. CONCLUSIONS Marked inconsistency exists in the performance of the ISNCSCI anal examination. Researchers and clinicians need more education about the performance of the examination. Consideration should be given for the components of deep rectal sensation and anal pressure to be separately documented in the neurologic exam and for researchers to focus separately on recovery of sacral function vs. ambulatory function in clinical trials.
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Affiliation(s)
- Marcalee Alexander
- Birmingham VA Medical Center, 700 South 19th Street, Birmingham, AL 35233 USA
- Department of Physical Medicine and Rehabilitation, University of Alabama School of Medicine, Birmingham, AL USA
- Department of Physical Medicine and Rehabilitation, Harvard School of Medicine, Boston, MA USA
| | - Hammad Aslam
- Department of Physical Medicine and Rehabilitation, University of Alabama School of Medicine, Birmingham, AL USA
| | - Ralph J. Marino
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA USA
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Development and validation of a bowel-routine-based self-report questionnaire for sacral sparing after spinal cord injury. Spinal Cord 2017; 55:1010-1015. [PMID: 28695901 DOI: 10.1038/sc.2017.77] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 05/23/2017] [Accepted: 05/24/2017] [Indexed: 02/06/2023]
Abstract
STUDY DESIGN An observational study. OBJECTIVE To develop a self-administered tool for assessment of sacral sparing after spinal cord injury (SCI) and to test its validity in individuals with SCI. SETTING Peking University Third Hospital, Beijing, China. METHODS A 5-item SCI sacral sparing self-report questionnaire was developed based on several events that most patients might experience during bowel routine. 102 participants who sustained SCI within 12 months were asked to complete the questionnaire followed by an anorectal examination. Agreements of answers to the questionnaire and the physical examination were analyzed. Sensitivity, specificity and Youden's index of each item was calculated. RESULTS The first four questions regarding the S4-5 sensation including deep anal pressure showed high agreement with the results of the physical examination (κ: 0.79-0.93). Sensitivity, specificity and Youden's index were also high (all above 80%). For the fifth question related to the voluntary anal contraction, the agreement was almost perfect with good sensitivity and specificity among patients without increased anal sphincter tone (AST). In patients with increased AST, the agreement was fair. CONCLUSION The validity of this questionnaire for the assessment of sacral sparing in up to 12 months post injury is good except for the motor function when there was increased AST. In some situations it could be considered as an alternative tool for digital rectal examination, especially when repeated examinations are not feasible. It is suggested that change of sacral sparing may be detected by the questionnaire.
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Chen Y, Heinemann AW. Current Research Outcomes From the Spinal Cord Injury Model Systems. Arch Phys Med Rehabil 2016; 97:1607-9. [DOI: 10.1016/j.apmr.2016.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 07/21/2016] [Indexed: 12/11/2022]
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