1
|
Dionne A, Richard-Denis A, Mac-Thiong JM. Predicting Complete versus Incomplete Long-Term Functional Independence after Acute AIS Grade D Spinal Cord Injury: A Prospective Cohort Study. Top Spinal Cord Inj Rehabil 2024; 30:50-58. [PMID: 39139773 PMCID: PMC11317641 DOI: 10.46292/sci23-00090] [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: 08/15/2024]
Abstract
Background The proportion of patients with American Spinal Injury Association Impairment Scale (AIS) grade D traumatic spinal cord injuries (tSCI) is increasing. Although initial motor deficits can be relatively mild, some individuals fail to recover functional independence. Objectives This study aims to identify factors associated with failure to reach complete functional independence after AIS grade D tSCI. Methods An observational prospective cohort study was conducted at a level 1 trauma center specialized in SCI care. A prospective cohort of 121 individuals with an AIS-D tSCI was considered. The baseline characteristics, length of acute stay, need for inpatient rehabilitation, and 12-month functional status were assessed. Univariate and classification and regression tree (CART) analyses were performed to identify factors associated with reaching complete versus incomplete functional independence (defined as perfect total SCIM III score at 12-month follow-up). Results There were 69.3%, 83.3%, and 61.4% individuals reaching complete independence in self-care, respiration/sphincter management, and mobility, respectively. A total of 64 individuals (52%) reached complete functional independence in all three domains. In the CART analysis, we found that patients are more likely to achieve complete functional independence when they have a baseline motor score ≥83 (65% individuals) and if they present fewer medical comorbidities (70% individuals if Charlson Comorbidity Index [CCI] ≤4). Conclusion About half of individuals with AIS grade D tSCI can expect complete long-term functional independence. It is important to recognize early during acute care individuals with baseline motor score <83 or a high burden of comorbidities (CCI ≥5) to optimize their rehabilitation plan.
Collapse
Affiliation(s)
- Antoine Dionne
- Faculty of Medicine, Université de Montréal, Centre-ville, Montréal, Québec, Canada
- Research Center, CIUSSS Nord-de-l’Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
| | - Andréane Richard-Denis
- Faculty of Medicine, Université de Montréal, Centre-ville, Montréal, Québec, Canada
- Research Center, CIUSSS Nord-de-l’Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
- Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
| | - Jean-Marc Mac-Thiong
- Faculty of Medicine, Université de Montréal, Centre-ville, Montréal, Québec, Canada
- Research Center, CIUSSS Nord-de-l’Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
- Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
| |
Collapse
|
2
|
Brüningk SC, Bourguignon L, Lukas LP, Maier D, Abel R, Weidner N, Rupp R, Geisler F, Kramer JLK, Guest J, Curt A, Jutzeler CR. Prediction of segmental motor outcomes in traumatic spinal cord injury: Advances beyond sum scores. Exp Neurol 2024; 380:114905. [PMID: 39097076 DOI: 10.1016/j.expneurol.2024.114905] [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: 03/01/2024] [Revised: 07/14/2024] [Accepted: 07/25/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND AND OBJECTIVES Neurological and functional recovery after traumatic spinal cord injury (SCI) is highly challenged by the level of the lesion and the high heterogeneity in severity (different degrees of in/complete SCI) and spinal cord syndromes (hemi-, ant-, central-, and posterior cord). So far outcome predictions in clinical trials are limited in targeting sum motor scores of the upper (UEMS) and lower limb (LEMS) while neglecting that the distribution of motor function is essential for functional outcomes. The development of data-driven prediction models of detailed segmental motor recovery for all spinal segments from the level of lesion towards the lowest motor segments will improve the design of rehabilitation programs and the sensitivity of clinical trials. METHODS This study used acute-phase International Standards for Neurological Classification of SCI exams to forecast 6-month recovery of segmental motor scores as the primary evaluation endpoint. Secondary endpoints included severity grade improvement, independent walking, and self-care ability. Different similarity metrics were explored for k-nearest neighbor (kNN) matching within 1267 patients from the European Multicenter Study about Spinal Cord Injury before validation in 411 patients from the Sygen trial. The kNN performance was compared to linear and logistic regression models. RESULTS We obtained a population-wide root-mean-squared error (RMSE) in motor score sequence of 0.76(0.14, 2.77) and competitive functional score predictions (AUCwalker = 0.92, AUCself-carer = 0.83) for the kNN algorithm, improving beyond the linear regression task (RMSElinear = 0.98(0.22, 2.57)). The validation cohort showed comparable results (RMSE = 0.75(0.13, 2.57), AUCwalker = 0.92). We deploy the final historic control model as a web tool for easy user interaction (https://hicsci.ethz.ch/). DISCUSSION Our approach is the first to provide predictions across all motor segments independent of the level and severity of SCI. We provide a machine learning concept that is highly interpretable, i.e. the prediction formation process is transparent, that has been validated across European and American data sets, and provides reliable and validated algorithms to incorporate external control data to increase sensitivity and feasibility of multinational clinical trials.
Collapse
Affiliation(s)
- Sarah C Brüningk
- Department of Health Sciences and Technology (D-HEST), ETH Zurich, Switzerland; SIB Swiss Institute of Bioinformatics, Switzerland.
| | - Lucie Bourguignon
- Department of Health Sciences and Technology (D-HEST), ETH Zurich, Switzerland; SIB Swiss Institute of Bioinformatics, Switzerland
| | - Louis P Lukas
- Department of Health Sciences and Technology (D-HEST), ETH Zurich, Switzerland; SIB Swiss Institute of Bioinformatics, Switzerland
| | - Doris Maier
- Spinal Cord Injury Center, Trauma Center Murnau, Murnau, Germany
| | - Rainer Abel
- Spinal Cord Injury Center, Klinikum Bayreuth, Bayreuth, Germany
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Rüdiger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Fred Geisler
- University of Saskatchewan, Saskatchewan, Canada
| | - John L K Kramer
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Canada; Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Canada; Hugill Centre for Anesthesia, University of British Columbia, Canada
| | - James Guest
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, USA; Department of Neurological Surgery, Miller School of Medicine, The University of Miami, Miami, USA
| | - Armin Curt
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Switzerland
| | - Catherine R Jutzeler
- Department of Health Sciences and Technology (D-HEST), ETH Zurich, Switzerland; SIB Swiss Institute of Bioinformatics, Switzerland
| |
Collapse
|
3
|
Ullah S, Qureshi AZ, AlWehaibi TA, Rathore FA, Sami W, Ayaz SB, AlKeid NH, Alibrahim MS, AlHabter AM, Alketheeri WB, Bashir MS. Functional priorities of individuals with spinal cord injury: a Saudi Arabian perspective. Spinal Cord 2024:10.1038/s41393-024-01018-0. [PMID: 39060481 DOI: 10.1038/s41393-024-01018-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 04/23/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024]
Abstract
CONTEXT/OBJECTIVE People with spinal cord injury (SCI) are the deciding force behind the rehabilitation program to improve their quality of life (QoL) based on their personal preferences. Here we aimed to determine the preferences perceived most vital by Saudi SCI population to improve their QoL, and explore if these preferences are affected by gender, education, and duration, level, or extent of injury. DESIGN Participants ranked seven priorities of bodily functions as Rank I-VII with "I" being "Most important," and "VII" being "Least important." SETTING Inpatient rehabilitation facility. PARTICIPANTS 120 participants (>18 years of age) of either sex with SCI without polytrauma, acquired brain injury, neurodegenerative disease, and dementia. OUTCOME MEASURES Ranking scale of seven priorities of bodily functions as Rank I-VII with "I" being "Most important," and "VII" being "Least important." RESULTS Of 101 individuals (mean age: 35.2 ± 14.8 years) finally included, 70.3% were males, 66.3% had onset of SCI since ≥ 3 years, 48.5% had a complete injury, and 75% had paraplegia. Most (26.7%) participants ranked walking as the first priority followed by hand/arm function (20.8%). Sexual function was the least important priority (39.6%). Hand/arm function was significantly more important for individuals with tetraplegia (p < 0.001). Trunk strength and balance was significantly less important for individuals with complete injury (p = 0.037). Participants with the onset of injury < 3 years and a complete injury reported bladder/bowel function as significantly more important (p = 0.011). Walking was significantly more important for people with incomplete injury and for people with injury duration ≥ 3 years (p = 0.022, p = 0.002 respectively). CONCLUSION The top priority in our sample of Saudi people with SCI was walking followed by hand/arm function while the least desired function was regaining sexual function. Walking was a prioritized function for people with injury duration ≥ 3 years and people with a complete injury while hand/arm function was highly prioritized by people with tetraplegia.
Collapse
Affiliation(s)
- Sami Ullah
- Department of Physical Medicine and Rehabilitation, King Fahad Medical City, Riyadh, Saudi Arabia
- Department of Physical Medicine and Rehabilitation, Qatar Rehabilitation Institute, Doha, Qatar
| | - Ahmad Zaheer Qureshi
- Department of Physical Medicine and Rehabilitation, King Fahad Medical City, Riyadh, Saudi Arabia.
| | - Talal Ali AlWehaibi
- Patient Education Department, Health Education Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Farooq Azam Rathore
- Department of Rehabilitation Medicine, PNS Shifa Hospital, Karachi, Pakistan
| | - Waqas Sami
- Department of Pre-Clinical Affairs, College of Nursing, QU-Health, Qatar University, Doha, P.O Box 2713, Qatar
| | - Saeed Bin Ayaz
- Department of Physical Medicine and Rehabilitation, Combined Military Hospital, Jhelum, Pakistan
| | - Nurah Hamad AlKeid
- Department of Physical Medicine and Rehabilitation, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Maryam Saif Alibrahim
- Department of Physical Medicine and Rehabilitation, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ahmed Mushabbab AlHabter
- Department of Physical Medicine and Rehabilitation, King Fahad Medical City, Riyadh, Saudi Arabia
- Medical Affairs, King Faisal Medical City, Abha, Saudi Arabia
| | - Wafa Bani Alketheeri
- Department of Physical Medicine and Rehabilitation, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammad Salman Bashir
- Department of Biostatistics, Research Services Administration, Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
| |
Collapse
|
4
|
Shen R, Lu Y, Cai C, Wang Z, Zhao J, Wu Y, Zhang Y, Yang Y. Research progress and prospects of benefit-risk assessment methods for umbilical cord mesenchymal stem cell transplantation in the clinical treatment of spinal cord injury. Stem Cell Res Ther 2024; 15:196. [PMID: 38956734 PMCID: PMC11218107 DOI: 10.1186/s13287-024-03797-y] [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: 12/17/2023] [Accepted: 06/10/2024] [Indexed: 07/04/2024] Open
Abstract
Over the past decade, we have witnessed the development of cell transplantation as a new strategy for repairing spinal cord injury (SCI). However, due to the complexity of the central nervous system (CNS), achieving successful clinical translation remains a significant challenge. Human umbilical cord mesenchymal stem cells (hUMSCs) possess distinct advantages, such as easy collection, lack of ethical concerns, high self-renewal ability, multilineage differentiation potential, and immunomodulatory properties. hUMSCs are promising for regenerating the injured spinal cord to a significant extent. At the same time, for advancing SCI treatment, the appropriate benefit and risk evaluation methods play a pivotal role in determining the clinical applicability of treatment plans. Hence, this study discusses the advantages and risks of hUMSCs in SCI treatment across four dimensions-comprehensive evaluation of motor and sensory function, imaging, electrophysiology, and autonomic nervous system (ANS) function-aiming to improve the rationality of relevant clinical research and the feasibility of clinical translation.
Collapse
Affiliation(s)
- Ruoqi Shen
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
- National Medical Products Administration (NMPA) Key Laboratory for Quality Research and Evaluation of Cell Products, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
- Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
- Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
| | - Yubao Lu
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
- National Medical Products Administration (NMPA) Key Laboratory for Quality Research and Evaluation of Cell Products, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
- Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
- Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
| | - Chaoyang Cai
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
- National Medical Products Administration (NMPA) Key Laboratory for Quality Research and Evaluation of Cell Products, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
- Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
- Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
| | - Ziming Wang
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
- National Medical Products Administration (NMPA) Key Laboratory for Quality Research and Evaluation of Cell Products, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
- Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
- Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
| | - Jiayu Zhao
- Department of Neuro-Oncological Surgery, Neurosurgery Center, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Yingjie Wu
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
- National Medical Products Administration (NMPA) Key Laboratory for Quality Research and Evaluation of Cell Products, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
- Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
- Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China
| | - Yinian Zhang
- Department of Neuro-Oncological Surgery, Neurosurgery Center, Zhujiang Hospital of Southern Medical University, Guangzhou, China.
| | - Yang Yang
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China.
- National Medical Products Administration (NMPA) Key Laboratory for Quality Research and Evaluation of Cell Products, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China.
- Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China.
- Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong Province, China.
| |
Collapse
|
5
|
Solinsky R, Burns K, Taylor JA, Singer W. Valsalva maneuver pressure recovery time is prolonged following spinal cord injury with correlations to autonomically-influenced secondary complications. Clin Auton Res 2024:10.1007/s10286-024-01040-5. [PMID: 38916658 DOI: 10.1007/s10286-024-01040-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/14/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE This work's purpose was to quantify rapid sympathetic activation in individuals with spinal cord injury (SCI), and to identify associated correlations with symptoms of orthostatic hypotension and common autonomically mediated secondary medical complications. METHODS This work was a cross-sectional study of individuals with SCI and uninjured individuals. Symptoms of orthostatic hypotension were recorded using the Composite Autonomic Symptom Score (COMPASS)-31 and Autonomic Dysfunction following SCI (ADFSCI) survey. Histories of secondary complications of SCI were gathered. Rapid sympathetic activation was assessed using pressure recovery time of Valsalva maneuver. Stepwise multiple linear regression models identified contributions to secondary medical complication burden. RESULTS In total, 48 individuals (24 with SCI, 24 uninjured) underwent testing, with symptoms of orthostatic hypotension higher in those with SCI (COMPASS-31, 3.3 versus 0.6, p < 0.01; ADFSCI, 21.2 versus. 3.2, p < 0.01). Pressure recovery time was prolonged after SCI (7.0 s versus. 1.7 s, p < 0.01), though poorly correlated with orthostatic symptom severity. Neurological level of injury after SCI influenced pressure recovery time, with higher injury levels associated with more prolonged time. Stepwise multiple linear regression models identified pressure recovery time as the primary explanation for variance in number of urinary tract infections (34%), histories of hospitalizations (12%), and cumulative secondary medical complication burden (24%). In all conditions except time for bowel program, pressure recovery time outperformed current clinical tools for assessing such risk. CONCLUSIONS SCI is associated with impaired rapid sympathetic activation, demonstrated here by prolonged pressure recovery time. Prolonged pressure recovery time after SCI predicts higher risk for autonomically mediated secondary complications, serving as a viable index for more "autonomically complete" injury.
Collapse
Affiliation(s)
- Ryan Solinsky
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, MN, USA.
- Spaulding Rehabilitation Hospital, Cambridge, MA, USA.
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Boston, MA, USA.
| | - Kathryn Burns
- Spaulding Rehabilitation Hospital, Cambridge, MA, USA
| | - J Andrew Taylor
- Spaulding Rehabilitation Hospital, Cambridge, MA, USA
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Boston, MA, USA
| | | |
Collapse
|
6
|
Ginzburg K, Greener H, Bondi M, Zeilig G, Defrin R. Predicting chronic pain two years following a spinal cord injury: Longitudinal study on the reciprocal role of acute pain and PTSD symptoms. J Spinal Cord Med 2024:1-10. [PMID: 38913447 DOI: 10.1080/10790268.2024.2361552] [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] [Indexed: 06/26/2024] Open
Abstract
OBJECTIVES To examine a) the development of PTSD symptoms and pain over five months post-spinal cord injury (SCI); b) the directional effects of PTSD symptoms and pain across five months post-SCI; and c) the prediction of chronic pain two-years post-SCI by PTSD symptoms and pain severity in the first five months post-SCI. STUDY DESIGN Two-year longitudinal study. SETTING : Individuals with an SCI admitted to the Department of Neurological Rehabilitation (N = 65). OUTCOME MEASURES : PTSD symptoms and pain were evaluated at 1.5 months (T1), three months (T2), and five months (T3) post-SCI. Chronic pain was evaluated at 24 months post-SCI (follow-up). RESULTS Seventy-five percent of participants reported chronic pain at follow-up. Pain severity at T1 and T2 predicted PTSD symptoms at T2 and T3, respectively. PTSD symptoms at T2 predicted pain severity at T3. Individuals with chronic pain at follow-up had reported more PTSD symptoms at T1, T2, and T3 than those without pain. A multivariate model yielded two significant indirect paths: a) PTSD symptoms at T1 predicted chronic pain severity at follow-up through PTSD symptoms at T2 and T3, and b) pain severity at T1 predicted chronic pain severity at follow-up through pain severity at T2 and T3. CONCLUSIONS Both pain and PTSD in the acute post-SCI phase are markers for chronic pain two years later. PTSD and chronic pain exhibit a complex, reciprocal relationship across time that contributes to pain chronicity. Identifying individuals at risk and implementing interventions targeting both pain and PTSD symptoms during the acute phase may prevent their chronification.
Collapse
Affiliation(s)
- Karni Ginzburg
- Tel Aviv University, Bob Shapell School of Social Work, Gershon H. Gordon Faculty of Social Sciences, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Hila Greener
- Department of Physiotherapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Moshe Bondi
- Department of Neurological Rehabilitation, Sheba Medical Center, Tel Hashomer, Israel and Department of Rehabilitation, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Gabi Zeilig
- Department of Neurological Rehabilitation, Sheba Medical Center, Tel Hashomer, Israel and Department of Rehabilitation, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Ruth Defrin
- Department of Physiotherapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| |
Collapse
|
7
|
Butler Forslund E, Truong MTN, Wang R, Seiger Å, Gutierrez-Farewik EM. A Protocol for Comprehensive Analysis of Gait in Individuals with Incomplete Spinal Cord Injury. Methods Protoc 2024; 7:39. [PMID: 38804333 PMCID: PMC11130903 DOI: 10.3390/mps7030039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/17/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
This is a protocol for comprehensive analysis of gait and affecting factors in individuals with incomplete paraplegia due to spinal cord injury (SCI). A SCI is a devastating event affecting both sensory and motor functions. Due to better care, the SCI population is changing, with a greater proportion retaining impaired ambulatory function. Optimizing ambulatory function after SCI remains challenging. To investigate factors influencing optimal ambulation, a multi-professional research project was grounded with expertise from clinical rehabilitation, neurophysiology, and biomechanical engineering from Karolinska Institutet, the Spinalis Unit at Aleris Rehab Station (Sweden's largest center for specialized neurorehabilitation), and the Promobilia MoveAbility Lab at KTH Royal Institute of Technology. Ambulatory adults with paraplegia will be consecutively invited to participate. Muscle strength, sensitivity, and spasticity will be assessed, and energy expenditure, 3D movements, and muscle function (EMG) during gait and submaximal contractions will be analyzed. Innovative computational modeling and data-driven analyses will be performed, including the identification of clusters of similar movement patterns among the heterogeneous population and analyses that study the link between complex sensorimotor function and movement performance. These results may help optimize ambulatory function for persons with SCI and decrease the risk of secondary conditions during gait with a life-long perspective.
Collapse
Affiliation(s)
- Emelie Butler Forslund
- Department of Neurobiology, Care Science and Society, Karolinska Institutet, 141 83 Stockholm, Sweden; (E.B.F.); (Å.S.)
- Aleris Rehab Station R&D Unit, 169 89 Solna, Sweden
| | - Minh Tat Nhat Truong
- KTH MoveAbility, Department of Engineering Mechanics, KTH Royal Institute of Technology, 100 44 Stockholm, Sweden; (M.T.N.T.); (R.W.)
| | - Ruoli Wang
- KTH MoveAbility, Department of Engineering Mechanics, KTH Royal Institute of Technology, 100 44 Stockholm, Sweden; (M.T.N.T.); (R.W.)
| | - Åke Seiger
- Department of Neurobiology, Care Science and Society, Karolinska Institutet, 141 83 Stockholm, Sweden; (E.B.F.); (Å.S.)
- Aleris Rehab Station R&D Unit, 169 89 Solna, Sweden
| | - Elena M. Gutierrez-Farewik
- KTH MoveAbility, Department of Engineering Mechanics, KTH Royal Institute of Technology, 100 44 Stockholm, Sweden; (M.T.N.T.); (R.W.)
- Department of Women’s and Children’s Health, Karolinska Institutet, 171 77 Stockholm, Sweden
| |
Collapse
|
8
|
Solinsky R, Park K, Betancourt L, Schmidt-Read M, Owens M, Schwab JM, Dusseau NB, Szlachcic Y, Sutherland L, Taylor JA, Nash MS. Patient Perceptions and Clinical Assessments of Cardiometabolic Disease After Subacute Spinal Cord Injury. Arch Phys Med Rehabil 2024; 105:901-905. [PMID: 38065229 DOI: 10.1016/j.apmr.2023.12.001] [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: 06/28/2023] [Revised: 11/24/2023] [Accepted: 12/01/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVES To investigate the effectiveness of health care team communication regarding cardiometabolic disease (CMD) risk factors with patients with subacute spinal cord injury (SCI). DESIGN Multi-site prospective cross-sectional study. SETTING Five National Institute on Disability, Independent Living, and Rehabilitation Research Model SCI Rehabilitation Centers. PARTICIPANTS Ninety-six patients with subacute SCI, aged 18-70 years, with SCI (neurologic levels of injury C2-L2, American Spinal Injury Association Impairment Scale grades A-D), and enrolled within 2 months of initial rehabilitation discharge (N=96). INTERVENTIONS None. MAIN OUTCOME MEASURE(S) Objective risk factors of CMD (body mass index, fasting glucose, insulin, high-density lipoprotein cholesterol, triglyceride levels, and resting blood pressure). Patient reported recall of these present risk factors being shared with them by their health care team. Medications prescribed to patients to address these present risk factors were checked against guideline- assessed risk factors. RESULTS Objective evidence of 197 CMD risk factors was identified, with patients recalling less than 12% of these (P<.0001) being shared with them by their health care team. Thirty-one individuals (32%) met criteria for a diagnosis of CMD, with only 1 of these patients (3.2%) recalling that this was shared by their health care team (P<.0001). Pharmacologic management was prescribed to address these risk factors only 7.2% of the time. CONCLUSIONS Despite high prevalence of CMD risk factors after acute SCI, patients routinely do not recall being told of their present risk factors. Multifaceted education and professionals' engagement efforts are needed to optimize treatment for these individuals.
Collapse
Affiliation(s)
- Ryan Solinsky
- Mayo Clinic, Rochester, MN; Spaulding Rehabilitation Hospital, Boston, MA.
| | | | - Luisa Betancourt
- The Miami Project to Cure Paralysis-University of Miami Miller School of Medicine, Miami, FL
| | - Mary Schmidt-Read
- Jefferson Health, Philadelphia, PA; Magee Rehabilitation Hospital, Philadelphia, PA
| | | | - Jan M Schwab
- Belford Center for Spinal Cord Injury, The Ohio State University, Wexner Medical Center, Columbus, OH; Spinal Cord Injury Medicine, Department of Neurology, The Ohio State University, Wexner Medical Center, Columbus, OH; Department of Physical Medicine and Rehabilitation, The Ohio State University, Wexner Medical Center, Columbus, OH
| | - Nathaniel B Dusseau
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Wexner Medical Center, Columbus, OH
| | - Yaga Szlachcic
- Southern California Spinal Cord Injury Model System, Downey, CA; Rancho Research Institute at Rancho, Los Amigos National Rehabilitation Center, Downey, CA
| | - Linda Sutherland
- Southern California Spinal Cord Injury Model System, Downey, CA; Rancho Research Institute at Rancho, Los Amigos National Rehabilitation Center, Downey, CA
| | | | - Mark S Nash
- The Miami Project to Cure Paralysis-University of Miami Miller School of Medicine, Miami, FL
| |
Collapse
|
9
|
Moritz C, Field-Fote EC, Tefertiller C, van Nes I, Trumbower R, Kalsi-Ryan S, Purcell M, Janssen TWJ, Krassioukov A, Morse LR, Zhao KD, Guest J, Marino RJ, Murray LM, Wecht JM, Rieger M, Pradarelli J, Turner A, D'Amico J, Squair JW, Courtine G. Non-invasive spinal cord electrical stimulation for arm and hand function in chronic tetraplegia: a safety and efficacy trial. Nat Med 2024; 30:1276-1283. [PMID: 38769431 PMCID: PMC11108781 DOI: 10.1038/s41591-024-02940-9] [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: 12/01/2023] [Accepted: 03/22/2024] [Indexed: 05/22/2024]
Abstract
Cervical spinal cord injury (SCI) leads to permanent impairment of arm and hand functions. Here we conducted a prospective, single-arm, multicenter, open-label, non-significant risk trial that evaluated the safety and efficacy of ARCEX Therapy to improve arm and hand functions in people with chronic SCI. ARCEX Therapy involves the delivery of externally applied electrical stimulation over the cervical spinal cord during structured rehabilitation. The primary endpoints were safety and efficacy as measured by whether the majority of participants exhibited significant improvement in both strength and functional performance in response to ARCEX Therapy compared to the end of an equivalent period of rehabilitation alone. Sixty participants completed the protocol. No serious adverse events related to ARCEX Therapy were reported, and the primary effectiveness endpoint was met. Seventy-two percent of participants demonstrated improvements greater than the minimally important difference criteria for both strength and functional domains. Secondary endpoint analysis revealed significant improvements in fingertip pinch force, hand prehension and strength, upper extremity motor and sensory abilities and self-reported increases in quality of life. These results demonstrate the safety and efficacy of ARCEX Therapy to improve hand and arm functions in people living with cervical SCI. ClinicalTrials.gov identifier: NCT04697472 .
Collapse
Affiliation(s)
- Chet Moritz
- Departments of Rehabilitation Medicine, Electrical & Computer Engineering, Physiology & Biophysics and Center for Neurotechnology, University of Washington, Seattle, WA, USA
| | - Edelle C Field-Fote
- Shepherd Center, Crawford Research Institute and Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Ilse van Nes
- Sint Maartenskliniek, Revalidatiegeneeskunde, Nijmegen, The Netherlands
| | - Randy Trumbower
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Sukhvinder Kalsi-Ryan
- KITE Research Institute|Toronto Rehab, University Health Network, Toronto, Ontario, Canada
| | - Mariel Purcell
- Scottish Centre for Innovation in Spinal Cord Injury, Queen Elizabeth National Spinal Injuries Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Thomas W J Janssen
- Amsterdam Rehabilitation Research Center | Reade, Amsterdam, The Netherlands
- Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Andrei Krassioukov
- ICORD and Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Leslie R Morse
- Department of Rehabilitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Kristin D Zhao
- Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, USA
| | - James Guest
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
- Miami Project to Cure Paralysis, Miami, FL, USA
| | - Ralph J Marino
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Lynda M Murray
- Departments of Rehabilitation and Human Performance and Medicine, James J. Peters VA Medical Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Research and Development, James J. Peters VA Medical Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jill M Wecht
- Department of Research and Development, James J. Peters VA Medical Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Jessica D'Amico
- ONWARD Medical, Lausanne, Switzerland
- Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jordan W Squair
- NeuroX Institute and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- Defitech Center for Interventional Neurotherapies (NeuroRestore), EPFL/CHUV/UNIL, Lausanne, Switzerland
- NeuroRestore, NeuroX Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Gregoire Courtine
- NeuroX Institute and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland.
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.
- Defitech Center for Interventional Neurotherapies (NeuroRestore), EPFL/CHUV/UNIL, Lausanne, Switzerland.
- NeuroRestore, NeuroX Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.
| |
Collapse
|
10
|
Mercier HW, Solinsky R, Taylor JA. Relationship of cardiometabolic disease risk factors with age and spinal cord injury duration. J Spinal Cord Med 2024; 47:379-386. [PMID: 35485952 PMCID: PMC11044727 DOI: 10.1080/10790268.2022.2065410] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
CONTEXT/OBJECTIVES Cardiometabolic disease (CMD) is increased after spinal cord injury (SCI), with an increased number of CMD risk factors that relate to higher mortality. The study objective was to characterize the relationship of age and injury duration with CMD. DESIGN Retrospective cohort assessment of CMD risks using unbiased recursive partitioning to divide for group comparison: (1) Lowest Risk, (2) Moderate Risk, and (3) Highest Risk based on classification and regression trees predicting CMD diagnosis by age and injury duration. SETTING Academic rehabilitation center laboratory. PARTICIPANTS Adults (N = 103; aged 18-75) with traumatic SCI (C4-L2) of 3 months to 42 years duration. INTERVENTIONS NA. OUTCOME MEASURES CMD risk factors (obesity, insulin resistance, dyslipidemia, and hypertension) using Paralyzed Veterans of America SCI-specific guidelines. RESULTS Obesity was prevalent (82%) and co-occurred with most other risk factors present. Age increased odds for CMD diagnosis by 1.05 per year (P = 0.02) and was directly related to elevated body mass index (BMI, β = 0.42, P < 0.05), fasting glucose (β = 0.58, P < 0.01), and higher systolic blood pressure (β = 0.31, P < 0.10). In contrast, time since injury contributed to lower risk factor count (β = -0.29, P < 0.10) and higher HDL-C (β = 0.50, P < 0.01), and was not related to odds of CMD diagnosis. CONCLUSION While SCI is linked to an increased risk of CMD, age is associated with higher CMD risk. Increased SCI duration related to improvement in individual CMD risk factors but did not decrease overall risk for CMD diagnosis. SCI may not uniformly increase CMD risks and highlight a necessary focus on weight management for risk prevention.
Collapse
Affiliation(s)
- Hannah W. Mercier
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital, Cambridge, Massachusetts, USA
| | - Ryan Solinsky
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital, Cambridge, Massachusetts, USA
| | - J. Andrew Taylor
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Cardiovascular Research Laboratory, Spaulding Rehabilitation Hospital, Cambridge, Massachusetts, USA
| |
Collapse
|
11
|
Shool S, Rahmani S, Habibi MA, Piri SM, Lotfinia M, Jashnani D, Asaadi S. Acute spinal cord injury serum biomarkers in human and rat: a scoping systematic review. Spinal Cord Ser Cases 2024; 10:21. [PMID: 38615029 PMCID: PMC11016077 DOI: 10.1038/s41394-024-00636-3] [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: 03/29/2023] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 04/15/2024] Open
Abstract
STUDY DESIGN Scoping systematic review. OBJECTIVES To summarize the available experimental clinical and animal studies for the identification of all CSF and serum-derived biochemical markers in human and rat SCI models. SETTING Tehran, Iran. METHODS In this scoping article, we systematically reviewed the electronic databases of PubMed, Scopus, WOS, and CENTRAL to retrieve current literature assessing the levels of different biomarkers in human and rat SCI models. RESULTS A total of 19,589 articles were retrieved and 6897 duplicated titles were removed. The remaining 12,692 studies were screened by their title/abstract and 12,636 were removed. The remaining 56 were considered for full-text assessment, and 11 papers did not meet the criteria, and finally, 45 studies were included. 26 studies were human observational studies comprising 1630 patients, and 19 articles studied SCI models in rats, including 832 rats. Upon reviewing the literature, we encountered a remarkable heterogeneity in terms of selected biomarkers, timing, and method of measurement, studied models, extent, and mechanism of injury as well as outcome assessment measures. CONCLUSIONS The specific expression and distribution patterns of biomarkers in relation to spinal cord injury (SCI) phases, and their varied concentrations over time, suggest that cerebrospinal fluid (CSF) and blood biomarkers are effective measures for assessing the severity of SCI.
Collapse
Affiliation(s)
- Sina Shool
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Hassan-Abad Square, Imam Khomeini Ave, 11365-3876, Tehran, Iran
| | - Saeed Rahmani
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Amin Habibi
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Hassan-Abad Square, Imam Khomeini Ave, 11365-3876, Tehran, Iran
| | - Seyed Mohammad Piri
- Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Hassan-Abad Square, Imam Khomeini Ave, 11365-3876, Tehran, Iran
| | - Mahmoud Lotfinia
- Resident of Neurosurgery, Department of Neurosurgery, Klinikum Saarbrücken, University of Saarland, Saarbrücken, Germany
| | - Delara Jashnani
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sina Asaadi
- Department of Surgery, Division of Acute Care Surgery, Loma Linda University, Loma Linda, CA, USA.
| |
Collapse
|
12
|
Fehlings MG, Tetreault LA, Hachem L, Evaniew N, Ganau M, McKenna SL, Neal CJ, Nagoshi N, Rahimi-Movaghar V, Aarabi B, Hofstetter CP, Wengel VT, Nakashima H, Martin AR, Kirshblum S, Rodrigues Pinto R, Marco RAW, Wilson JR, Kahn DE, Newcombe VFJ, Zipser CM, Douglas S, Kurpad SN, Lu Y, Saigal R, Samadani U, Arnold PM, Hawryluk GWJ, Skelly AC, Kwon BK. An Update of a Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Role and Timing of Decompressive Surgery. Global Spine J 2024; 14:174S-186S. [PMID: 38526922 DOI: 10.1177/21925682231181883] [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] [Indexed: 03/27/2024] Open
Abstract
STUDY DESIGN Clinical practice guideline development. OBJECTIVES Acute spinal cord injury (SCI) can result in devastating motor, sensory, and autonomic impairment; loss of independence; and reduced quality of life. Preclinical evidence suggests that early decompression of the spinal cord may help to limit secondary injury, reduce damage to the neural tissue, and improve functional outcomes. Emerging evidence indicates that "early" surgical decompression completed within 24 hours of injury also improves neurological recovery in patients with acute SCI. The objective of this clinical practice guideline (CPG) is to update the 2017 recommendations on the timing of surgical decompression and to evaluate the evidence with respect to ultra-early surgery (in particular, but not limited to, <12 hours after acute SCI). METHODS A multidisciplinary, international, guideline development group (GDG) was formed that consisted of spine surgeons, neurologists, critical care specialists, emergency medicine doctors, physical medicine and rehabilitation professionals, as well as individuals living with SCI. A systematic review was conducted based on accepted methodological standards to evaluate the impact of early (within 24 hours of acute SCI) or ultra-early (in particular, but not limited to, within 12 hours of acute SCI) surgery on neurological recovery, functional outcomes, administrative outcomes, safety, and cost-effectiveness. The GRADE approach was used to rate the overall strength of evidence across studies for each primary outcome. Using the "evidence-to-recommendation" framework, recommendations were then developed that considered the balance of benefits and harms, financial impact, patient values, acceptability, and feasibility. The guideline was internally appraised using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. RESULTS The GDG recommended that early surgery (≤24 hours after injury) be offered as the preferred option for adult patients with acute SCI regardless of level. This recommendation was based on moderate evidence suggesting that patients were 2 times more likely to recover by ≥ 2 ASIA Impairment Score (AIS) grades at 6 months (RR: 2.76, 95% CI 1.60 to 4.98) and 12 months (RR: 1.95, 95% CI 1.26 to 3.18) if they were decompressed within 24 hours compared to after 24 hours. Furthermore, patients undergoing early surgery improved by an additional 4.50 (95% 1.70 to 7.29) points on the ASIA Motor Score compared to patients undergoing surgery after 24 hours post-injury. The GDG also agreed that a recommendation for ultra-early surgery could not be made on the basis of the current evidence because of the small sample sizes, variable definitions of what constituted ultra-early in the literature, and the inconsistency of the evidence. CONCLUSIONS It is recommended that patients with an acute SCI, regardless of level, undergo surgery within 24 hours after injury when medically feasible. Future research is required to determine the differential effectiveness of early surgery in different subpopulations and the impact of ultra-early surgery on neurological recovery. Moreover, further work is required to define what constitutes effective spinal cord decompression and to individualize care. It is also recognized that a concerted international effort will be required to translate these recommendations into policy.
Collapse
Affiliation(s)
- Michael G Fehlings
- Department of Surgery, Division of Neurosurgery and Spine Program, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | | | - Laureen Hachem
- Department of Surgery, Division of Neurosurgery and Spine Program, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Nathan Evaniew
- Department of Surgery, Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mario Ganau
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Chris J Neal
- Department of Surgery, Uniformed Services University, Bethesda, MD, USA
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bizhan Aarabi
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Valerie Ter Wengel
- Department of Neurosurgery, Amsterdam UMC VUMC Site, Amsterdam, Netherlands
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Allan R Martin
- Department of Neurological Surgery, University of California-Davis, Sacramento, CA, USA
| | - Steven Kirshblum
- Kessler Institute for Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Ricardo Rodrigues Pinto
- Spinal Unit (UVM), Centro Hospitalar Universitário de Santo António, Hospital CUF Trindade, Porto, Portugal
| | - Rex A W Marco
- Department of Orthopedic Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Jefferson R Wilson
- Department of Surgery, Division of Neurosurgery and Spine Program, University of Toronto, Toronto, ON, Canada
| | - David E Kahn
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA
| | - Virginia F J Newcombe
- Department of Medicine, University Division of Anaesthesia and PACE, University of Cambridge, Cambridge, UK
| | - Carl M Zipser
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Sam Douglas
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
| | - Shekar N Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Yi Lu
- Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Rajiv Saigal
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Uzma Samadani
- Department of Surgery, Minneapolis Veterans Affairs, Minneapolis, MN, USA
| | - Paul M Arnold
- Department of Neurosurgery, University of Illinois Champaign-Urbana, Urbana, IL, USA
| | | | | | - Brian K Kwon
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
13
|
Schuld C, Kirshblum S, Tansey K, Rupp R. The revised zone of partial preservation (ZPP) in the 2019 International Standards for Neurological Classification of Spinal Cord Injury: ZPP applicability in incomplete injuries. Spinal Cord 2024; 62:79-87. [PMID: 38191920 PMCID: PMC10853064 DOI: 10.1038/s41393-023-00950-x] [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: 01/24/2022] [Revised: 11/17/2023] [Accepted: 12/13/2023] [Indexed: 01/10/2024]
Abstract
STUDY DESIGN Consensus process. OBJECTIVES To provide a reference for the Zone(s) of Partial Preservation (ZPP) in the 2019 International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and analyze the initial impact of applicability of the revised ZPPs. Revisions include the use of ZPPs in selected incomplete injuries (in addition to prior use in sensorimotor complete injuries). Specifically, the revised motor ZPPs are applicable bilaterally in injuries with absent voluntary anal contraction (VAC) and the revised sensory ZPP for a given side is applicable if deep anal pressure (DAP), light touch and pin prick sensation in S4-5 are absent on that side. SETTING Committee with 16 ISNCSCI experts and datasets from the European Multicenter Study about Spinal Cord Injury (EMSCI). METHODS Occurrence frequencies of applicable ZPPs were determined in an EMSCI cohort consisting of two ISNCSCI examinations from 665 individuals with traumatic SCI. RESULTS Motor ZPPs were derived in 35.2% of all datasets of incomplete injuries, while sensory ZPPs are much less frequent (1.0%). Motor ZPPs are applicable in all American Spinal Injury Association Impairment Scale (AIS) B datasets (mean ZPP length: 0.9 ± 1.0 segments), in 55.4% of all AIS C datasets (ZPP length: 11.8 ± 8.2 segments) and in 9.9% of the AIS D datasets (ZPP length: 15.4 ± 7.9 segments). CONCLUSIONS The revised ZPP allows for determining motor ZPPs in approximately 1/3 of all incomplete injuries. The broadened applicability enables the use of ZPPs beyond complete injuries for complementary description of residual functions in more individuals. SPONSORSHIP N/A.
Collapse
Affiliation(s)
- Christian Schuld
- Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany
| | - Steven Kirshblum
- Kessler Institute for Rehabilitation, West Orange, NJ, USA
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Keith Tansey
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, MS, USA
- Spinal Cord Injury Clinic, Jackson VA Medical Center, Jackson, MS, USA
- Departments of Neurosurgery and Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, MS, USA
| | - Rüdiger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany.
| |
Collapse
|
14
|
Neyaz O, Kanaujia V, Yadav RK, Sarkar B, Azam MQ, Kandwal P. Epidemiology of Traumatic Spinal Cord Injury in the Himalayan Range and Sub-Himalayan region: A Retrospective Hospital Data-Based Study. Ann Rehabil Med 2024; 48:86-93. [PMID: 38151970 PMCID: PMC10915302 DOI: 10.5535/arm.23107] [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: 07/27/2023] [Revised: 10/21/2023] [Accepted: 11/01/2023] [Indexed: 12/29/2023] Open
Abstract
OBJECTIVE To compile epidemiological characteristics of traumatic spinal cord injury (TSCI) in the Northern Indian Himalayan regions and Sub-Himalayan planes. METHODS The present study is a retrospective, cross-sectional descriptive analysis based on hospital data conducted at the Department of Physical Medicine and Rehabilitation and Spine Unit of Trauma Centre in a tertiary care hospital in Uttarakhand, India. People hospitalized at the tertiary care center between August 2018 and November 2021 are included in the study sample. A prestructured proforma was employed for the evaluation, including demographic and epidemiological characteristics. RESULTS TSCI was found in 167 out of 3,120 trauma patients. The mean age of people with TSCI was 33.5±13.3, with a male-to-female ratio of 2.4:1. Eighty-three participants (49.7%) were from the plains, while the hilly region accounts for 50.3%. People from the plains had a 2.9:1 rural-to-urban ratio, whereas the hilly region had a 6:1 ratio. The overall most prevalent cause was Falls (59.3%), followed by road traffic accidents (RTAs) (35.9%). RTAs (57.2%) were the most common cause of TSCI in the plains' urban regions, while Falls (58.1%) were more common in rural plains. In both urban (66.6%) and rural (65.3%) parts of the hilly region, falls were the most common cause. CONCLUSION TSCI is more common in young males, especially in rural hilly areas. Falls rather than RTAs are the major cause.
Collapse
Affiliation(s)
- Osama Neyaz
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Rishikesh, India
| | - Vinay Kanaujia
- Department of Physical Medicine and Rehabilitation, Uttar Pradesh University of Medical Sciences, Saifai, India
| | - Raj Kumar Yadav
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Rishikesh, India
| | - Bhaskar Sarkar
- Department of Trauma Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Md. Quamar Azam
- Department of Trauma Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Pankaj Kandwal
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| |
Collapse
|
15
|
Maggio MG, Bonanno M, Manuli A, Calabrò RS. Improving Outcomes in People with Spinal Cord Injury: Encouraging Results from a Multidisciplinary Advanced Rehabilitation Pathway. Brain Sci 2024; 14:140. [PMID: 38391715 PMCID: PMC10886543 DOI: 10.3390/brainsci14020140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024] Open
Abstract
Spinal cord injury (SCI) consists of damage to any segment of the spinal cord extending to potential harm to nerves in the cauda equina. Rehabilitative efforts for SCI can involve conventional physiotherapy, innovative technologies, as well as cognitive treatment and psychological support. The aim of this study is to evaluate the feasibility of a dedicated, multidisciplinary, and integrated intervention path for SCI, encompassing both conventional and technological interventions, while observing their impact on cognitive, motor, and behavioral outcomes and the overall quality of life for individuals with SCI. Forty-two patients with SCI were included in the analysis utilizing electronic recovery system data. The treatment regimen included multidisciplinary rehabilitation approaches, such as traditional physiotherapy sessions, speech therapy, psychological support, robotic devices, advanced cognitive rehabilitation, and other interventions. Pre-post comparisons showed a significant improvement in lower limb function (Fugl Meyer Assessment-FMA < 0.001), global cognitive functioning (Montreal Cognitive Assessment-MoCA p < 0.001), and perceived quality of life at both a physical and mental level (Short Form-12-SF-12 p < 0.001). Furthermore, we found a significant reduction in depressive state (Beck Depression Inventory-BDI p < 0.001). In addition, we assessed patient satisfaction using the Short Form of the Patient Satisfaction Questionnaire (PSQ), offering insights into the subjective evaluation of the intervention. In conclusion, this retrospective study provides positive results in terms of improvements in motor function, cognitive functions, and quality of life, highlighting the importance of exploring multidisciplinary approaches.
Collapse
Affiliation(s)
- Maria Grazia Maggio
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98123 Messina, Italy
| | - Mirjam Bonanno
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98123 Messina, Italy
| | - Alfredo Manuli
- A.O.U. Policlinico "G. Martino", Via Consolare Valeria, 98124 Messina, Italy
| | | |
Collapse
|
16
|
Schieber MR, Schubert AK, Hubner W, Volk T. Influence of antithrombotic medication on size and neurological outcome of spinal epidural hematoma after neuraxial anesthesia: a systematic review. Reg Anesth Pain Med 2023:rapm-2023-104864. [PMID: 38129095 DOI: 10.1136/rapm-2023-104864] [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: 07/17/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Anticoagulation guidelines were developed to reduce the potential risk of epidural bleeding following neuraxial anesthesia. However, the influence of antithrombotic medication on size of spinal epidural hematoma and neurological outcome is unclear. Therefore, our aim was to analyze whether there is a correlation. METHODS The study was registered at Prospero (CRD42021285833). A systematic search in MEDLINE, EMBASE, CENTRAL, Web of Science and Google Scholar was conducted in August 2023 for studies reporting spinal epidural hematoma following neuraxial anesthesia. Primary endpoints were segmental extension and neurological outcome. Secondary endpoints were age, sex, body mass index, predisposition, American Society of Anesthesiologists physical status, complicated puncture, multiple punctures, bloody puncture, successful puncture, catheter usage, needle size and worst neurological deficit before treatment. Prespecified multivariate regression and propensity score matching was performed. Publications reporting on more than one patient were critically appraised. RESULTS A total of 345 cases reported in 304 publications were included. Size of hematoma was not significantly different (antithrombotic medication: OR 0.11, 95% CI (-0.67 to 0.89), p=0.78, 'non-guideline adherent' for puncture/removal: OR 0.13, 95% CI (-0.92 to 1.18), p=0.81). Patients receiving antithrombotic medication were more likely to have persistent neurological deficit (OR 2.00, 95% CI 1.24 to 3.23), p<0.01). Significance persisted after propensity score matching (p=0.04). Patients with non-guideline adherence had a 3.42 higher chance of persistent neurological deficit (95% CI 1.71 to 6.86, p<0.001). DISCUSSION Antithrombotic medication is not significantly associated with hematoma size; however, the use of antithrombotic medication doubled the risk for persistent neurological deficit after spinal epidural hematoma.
Collapse
Affiliation(s)
- Mirjam Ruth Schieber
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
| | | | - Wakiko Hubner
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
| | - Thomas Volk
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
| |
Collapse
|
17
|
Chung NS, Lee HD, Park KH, Lee JW, Chung HW. Pediatric Spinal Trauma at a Single Level 1 Trauma Center: Review of 62 Cases. Clin Orthop Surg 2023; 15:888-893. [PMID: 38045581 PMCID: PMC10689226 DOI: 10.4055/cios23118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 12/05/2023] Open
Abstract
Background Traumatic spinal injuries in children are uncommon and result in different patterns of injuries due to the anatomical characteristics of children's spines. However, there are only a few epidemiological studies of traumatic spinal injury in children. The purpose of this study was to investigate the characteristics of traumatic spinal injury in children. Methods We retrospectively reviewed the cases of pediatric patients (age < 18 years) with traumatic spinal injury who were treated at a level 1 trauma center between January 2017 and December 2021. We divided them into three groups according to age and analyzed demographics, injury mechanism, level of injury, and injury pattern. Results A total of 62 patients (255 fractures) were included, and the mean age was 13.8 ± 3.2 years. There were 5 patients (22 fractures) in group I (0-9 years), 24 patients (82 fractures) in group II (10-14 years), and 33 patients (151 fractures) in group III (15-17 years). Both the Injury Severity Score and the Revised Trauma Score were highest in group I, but there was no statistical difference between the age groups. Fall from height was the most common injury mechanism, of which 63% were suicide attempts. The level of spinal injury was different in each age group, T10-L2 injury being the most common. In all age groups, the number of multilevel continuous injury was larger than that of single-level injury or multilevel noncontinuous injury. Surgical intervention was required in 33.9%, and mortality was 3.2%. Conclusions In our study, fall from height was the most common mechanism of injury, and there were many suicide attempts associated with mental health issues. Thoracolumbar junction injuries were predominant, and the rate of multilevel contiguous injuries was high. The support and interest of the society and families for adolescent children seem crucial in preventing spinal trauma, and image testing of the entire spine is essential when evaluating pediatric spinal injuries.
Collapse
Affiliation(s)
- Nam-Su Chung
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Han-Dong Lee
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Ki-Hoon Park
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Jong Wha Lee
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Hee-Woong Chung
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, Korea
| |
Collapse
|
18
|
Park TS, Shin MJ, Shin YB, Kim SH. A new balance assessment tool for quantifying balance impairment in patients with motor incomplete spinal cord injury: Pilot study. J Spinal Cord Med 2023; 46:941-949. [PMID: 34723782 PMCID: PMC10653740 DOI: 10.1080/10790268.2021.1992592] [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: 10/20/2022] Open
Abstract
OBJECTIVE This study aimed to quantitatively and objectively evaluate the balance impairment in patients with motor incomplete spinal cord injury (SCI) using a new evaluation tool for balance and to assess its role in comprehensive balance assessment. DESIGN Retrospective pilot study. SETTING Rehabilitation hospital. PARTICIPANTS 14 patients with motor incomplete spinal cord injury. INTERVENTIONS None. OUTCOME MEASURES We retrospectively compared and analyzed the results of 14 patients with motor incomplete SCI who underwent various balance assessments, including the FRA510S test, using correlation. RESULTS The agreement between the FRA510S and existing balance assessment was confirmed through Bland-Altman plots; moreover, high degree of agreement was observed in Berg Balance Scale in the eye closed state and in Five Times Sit-to-Stand Test in the eye open state. CONCLUSIONS It was confirmed that the FRA510S equipment provides quantitative values for balance function. Balance assessment using the FRA510S, along with neurological, electrophysiological, and clinical tests, may provide comprehensive additional information related to falls and gait rehabilitation in patients with SCI.
Collapse
Affiliation(s)
- Tae Sung Park
- Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Myung-Jun Shin
- Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
- Pusan National University School of Medicine, Busan, Republic of Korea
| | - Yong Beom Shin
- Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
- Pusan National University School of Medicine, Busan, Republic of Korea
| | - Sang Hun Kim
- Department of Rehabilitation Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| |
Collapse
|
19
|
Collins J, Lizarondo L, Taylor S, Porritt K. Adult patient and carer experiences of planning for hospital discharge after a major trauma event: a qualitative systematic review. Disabil Rehabil 2023; 45:3435-3455. [PMID: 36299236 DOI: 10.1080/09638288.2022.2133180] [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: 01/02/2021] [Accepted: 09/25/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To identify, evaluate and synthesize qualitative literature on adult patients and carer experiences of planning for discharge from an acute setting after a major trauma event. METHODS The JBI approach to meta-aggregation was followed. Qualitative studies exploring patient and carer discharge planning experiences of major trauma were included in the systematic review. A comprehensive search was conducted in five databases, supplemented by grey literature. Eligible studies were appraised for methodological quality by two reviewers and data extracted using standardized JBI tools. RESULTS Four synthesized findings emerged using 69 findings from sixteen papers. (i) Patients and carers feel generally unprepared to manage at home after discharge, (ii) early identification of patients' post discharge needs allows for appropriate referrals and supports to be organised prior to discharge, (iii) patients and carers value participation in the discharge planning process to facilitate a considered, organized and timely discharge from hospital (iv) the timely presentation, delivery, language used, format and relevancy of information impacts how patients and carers manage their discharge. CONCLUSION This meta-synthesis demonstrates that patients and carers predominantly have poor experiences of discharge planning after major trauma. Adoption of patient centered principles may improve patient and carer experiences of the discharge planning process. IMPLICATIONS FOR REHABILITATIONPatients and their carers benefit from a client-centred approach where their needs are recognised and their collaboration encouraged in important decisions, and if they are adequately prepared to reintegrate into their community.Patients can benefit from having a trauma pathway healthcare professional to provide support and advocacy services throughout their hospital admission and after discharge.Discharge planning that is organised, prepared and collaborative leads to a more positive patient experience.Discharge information should be individualised and presented in an easily accessible format for patients and carers.
Collapse
Affiliation(s)
- Jeanette Collins
- JBI, University of Adelaide, Adelaide, Australia
- Jeanette Collins, Rehabilitation in the Home (RITH), Perth, Australia
| | | | - Susan Taylor
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- Occupational Therapy Department, Perth Children's Hospital, Child and Adolescent Health Service, Perth, Australia
| | | |
Collapse
|
20
|
Su CC, Lin YP, Yen HK, Pan YT, Zijlstra H, Verlaan JJ, Schwab JH, Lai CY, Hu MH, Yang SH, Groot OQ. A Machine Learning Algorithm for Predicting 6-Week Survival in Spinal Metastasis: An External Validation Study Using 2,768 Taiwanese Patients. J Am Acad Orthop Surg 2023; 31:e645-e656. [PMID: 37192422 DOI: 10.5435/jaaos-d-23-00091] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/11/2023] [Indexed: 05/18/2023] Open
Abstract
INTRODUCTION There are predictive algorithms for predicting 3-month and 1-year survival in patients with spinal metastasis. However, advance in surgical technique, immunotherapy, and advanced radiation therapy has enabled shortening of postoperative recovery, which returns dividends to the overall quality-adjusted life-year. As such, the Skeletal Oncology Research Group machine learning algorithm (SORG-MLA) was proposed to predict 6-week survival in patients with spinal metastasis, whereas its utility for patients treated with nonsurgical treatment was untested externally. This study aims to validate the survival prediction of the 6-week SORG-MLA for patients with spinal metastasis and provide the measurement of model consistency (MC). METHODS Discrimination using area under the receiver operating characteristic curve, calibration, Brier score, and decision curve analysis were conducted to assess the model's performance in the Taiwanese-based cohort. MC was also applied to detect the proportion of paradoxical predictions among 6-week, 3-month, and 1-year survival predictions. The long-term prognosis should not be better than the shorter-term prognosis in that of an individual. RESULTS The 6-week survival rate was 84.2%. The SORG-MLA retained good discrimination with an area under the receiver operating characteristic curve of 0.78 (95% confidence interval, 0.75 to 0.80) and good prediction accuracy with a Brier score of 0.11 (null model Brier score 0.13). There is an underestimation of the 6-week survival rate when the predicted survival rate is less than 50%. Decision curve analysis showed that the model was suitable for use over all threshold probabilities. MC showed suboptimal consistency between 6-week and 90-day survival prediction (78%). CONCLUSIONS The results of this study supported the utility of the algorithm. The online tool ( https://sorg-apps.shinyapps.io/spinemetssurvival/ ) can be used by both clinicians and patients in informative decision-making discussion before management of spinal metastasis.
Collapse
Affiliation(s)
- Chih-Chi Su
- From the Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei City, Taiwan (Su, Lin, Hu, and Yang), the Department of Medical Education, National Taiwan University Hospital, Taipei City, Taiwan (Su and Pan), the Department of Medical Education, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan (Yen), the Department of Orthopaedic Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan (Lai), the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Zijlstra, Schwab, and Groot), and the Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands (Zijlstra, Verlaan, and Groot)
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Krisa L, Witoslawski E, Jones L, Mulcahey MJ, Fouad K. Connecting Researchers and Clinicians Before Connecting the Injured Spinal Cord. Top Spinal Cord Inj Rehabil 2023; 29:14-30. [PMID: 38076290 PMCID: PMC10644858 DOI: 10.46292/sci22-00044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Background Translating research findings from animal models of spinal cord injury (SCI) to humans is a challenging enterprise. It is likely that differences in the use of common terms contribute to this. Objectives The purpose of this study was to identify how scientists and clinicians define terms used across the research and clinical care continuum. Methods We utilized the Delphi technique to develop consensus on the opinions of experts (defined as researchers and/or clinicians working in the field of SCI) through a series of structured, iterative surveys. A focus group of stakeholders developed the terms on the initial survey. Results were used to create definitions and formulate questions for a second and third survey. Results Survey 1 yielded one definition for eight terms and multiple definitions for six terms in addition to three new terms that respondents believed should be defined. In Survey 2, definitions for eight terms reached at least 80% agreement: anatomically complete spinal cord injury, functionally complete spinal cord injury, neuromodulation, physical exercise, physical rehabilitation, plasticity, task specificity, and training intensity. Consensus was not reached for six terms. In Survey 3, definitions for seven additional terms reached at least 80% agreement: recovery, repair, compensation, regeneration, physical function, physiological function, and chronic. There were three terms that did not reach agreement after the three rounds: acute, translational research, and sprouting. Conclusion We found that different terminology contributes to the gap between preclinical and clinical research and clinical application. This suggests that increased communication among different disciplines could be a way to advance the field.
Collapse
Affiliation(s)
- Laura Krisa
- Department of Physical Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Erica Witoslawski
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Linda Jones
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - MJ Mulcahey
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Karim Fouad
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta
| |
Collapse
|
22
|
Wouda MF, Slettahjell HB, Lundgaard E, Bastani NE, Raastad T, Blomhoff R, Kostovski E. Acute changes in antioxidants and oxidative stress to vigorous arm exercise: an intervention trial in persons with spinal cord injury and healthy controls. Spinal Cord Ser Cases 2023; 9:32. [PMID: 37443310 DOI: 10.1038/s41394-023-00590-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
STUDY DESIGN Intervention trial. BACKGROUND Literature remains unclear on possible health benefits and risks assosciated with high intensity exercise for persons with SCI. Elevated oxidative stress levels might influence their ability to exercise at high intensity. We investigated several biomarkers of oxidative stress and antioxidant defense at rest, during and after vigorous exercise among persons with chronic SCI. SETTING Sunnaas Rehabilitation Hospital, Norway. METHODS Six participants (five males) with chronic SCI (AIS A, injury level thoracic 2-8, >1 year postinjury) and six matched able-bodied controls performed two maximal arm-cranking tests, with one-three days in between. During the second exercise test, participants performed three bouts with four minutes arm cranking at high intensity (85-95% of peak heart rate (HRpeak)), before they reached maximal effort. Blood and urine biomarkers for oxidative stress and antioxidant levels were collected at six time points at the day of the second exercise test; baseline, at high intensity exercise, at maximal effort, at five, 30 and 60 min post-exercise, and 24 h post exercise. RESULTS Participants with SCI had significant lower levels of creatinine (∆16 µmol/L, p = 0.03), α-carotene (∆0.14 nmol/L, p < 0.001) and β-carotene (∆0.51 nmol/L, p = 0.001) at baseline compared to controls. Urine and blood biomarkers of oxidative stress and antioxidant levels showed similar response to vigorous exercise in the SCI and control group. CONCLUSIONS SCI participants showed similar changes in redox status during high intensity exercise compared to matched able-bodied. SCI participants had lower levels of exogen antioxidants both before, during and after vigorous exercise.
Collapse
Affiliation(s)
- Matthijs F Wouda
- Sunnaas Rehabilitation Hospital, Research department, Nesoddtangen, Norway.
| | - Hanne Bjørg Slettahjell
- Sunnaas Rehabilitation Hospital, Research department, Nesoddtangen, Norway
- University of Oslo, Department of Nutrition, Institute of Basic Medical Sciences, Oslo, Norway
| | - Eivind Lundgaard
- Sunnaas Rehabilitation Hospital, Research department, Nesoddtangen, Norway
| | - Nasser E Bastani
- University of Oslo, Department of Nutrition, Institute of Basic Medical Sciences, Oslo, Norway
| | - Truls Raastad
- Norwegian School of Sport Sciences, Department of Physical Performance, Oslo, Norway
| | - Rune Blomhoff
- University of Oslo, Department of Nutrition, Institute of Basic Medical Sciences, Oslo, Norway
- Oslo University Hospital, Department of Clinical Service, Division of Cancer Medicine, Oslo, Norway
| | | |
Collapse
|
23
|
Yang H, Han D, Li X. Endoscopic Decompression Combined with Percutaneous Pedicle Screw Fixation for Treating Thoracolumbar Burst Fractures with Neurological Deficits: Technical Note and Early Outcomes. World Neurosurg 2023; 173:e521-e531. [PMID: 36841532 DOI: 10.1016/j.wneu.2023.02.088] [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: 02/03/2023] [Accepted: 02/16/2023] [Indexed: 02/26/2023]
Abstract
OBJECTIVE The aim of this study is to introduce surgical technique of endoscopic decompression combined with percutaneous pedicle screw fixation (PPSF) for thoracolumbar burst fractures (TLBFs) with neurological deficits and evaluate its efficacy. METHODS A total of 32 patients with TLBFs and neurological deficits who were treated by endoscopic decompression combined with PPSF from June 2018 to August 2019 were included in this study. The effect of decompression was analyzed using canal encroachment ratio, while deformity correction was assessed using the sagittal Cobb angle and the percentage of anterior vertebral height. We also analyzed other clinical outcomes such as visual analog scale, Oswestry Disability Index, and American Spinal Injury Association impairment scale dose. RESULTS The patients were followed up for an average of 16 months. Our data showed that the patients' mean operation time was 153.75 minutes, the mean intraoperative blood loss was 48.84 mL, and the mean incision length was 7.78 cm. The canal encroachment ratio decreased from 55.91% ± 12.27% to 12.44% ± 3.91% (P < 0.05), sagittal Cobb angle decreased from 17.09° ± 5.46° to 5.72° ± 3.68° (P < 0.05), while the percentage of anterior vertebral height increased from 53.72% ± 8.99% to 83.22% ± 8.21% (P < 0.05). In addition, there was a significant improvement in the visual analog scale score, Oswestry Disability Index, and American Spinal Injury Association impairment scale classification (P < 0.05). Screw fracture occurred only in one patient during follow-up. CONCLUSIONS Endoscopic decompression combined with PPSF in the treatment of TLBFs with neurological deficits is safe and effective, which is a new minimally invasive method for the treatment of such diseases.
Collapse
Affiliation(s)
- Huiming Yang
- Department of Orthopedics, Shehong Municipal Hospital of Traditional Chinese Medicine, Shehong, Sichuan, China; Sichuan Li Xuan Traditional Chinese Medicine Studio, Shehong, Sichuan, China
| | - Dan Han
- Department of Orthopedics, Shehong Municipal Hospital of Traditional Chinese Medicine, Shehong, Sichuan, China.
| | - Xuan Li
- Department of Orthopedics, Shehong Municipal Hospital of Traditional Chinese Medicine, Shehong, Sichuan, China; Sichuan Li Xuan Traditional Chinese Medicine Studio, Shehong, Sichuan, China
| |
Collapse
|
24
|
Richard-Denis A, Dionne A, Mputu PM, Mac-Thiong JM. Do all patients with functional motor-incomplete (AIS-D) traumatic spinal cord injury need specialized inpatient functional rehabilitation? A prospective observational cohort study proposing clinical criteria for home-based rehabilitation after acute care. J Spinal Cord Med 2023:1-12. [PMID: 37083554 DOI: 10.1080/10790268.2023.2200354] [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] [Indexed: 04/22/2023] Open
Abstract
CONTEXT/OBJECTIVE Functional motor-incomplete AIS-D traumatic spinal cord injury (tSCI) represents an important growing population in neuro-traumatology. There is thus an important need for establishing strategies to optimize SCI rehabilitation resources. This study aims at proposing eligibility criteria to select individuals who could be discharged home (home-based rehabilitation) after acute care following an AIS-D tSCI and investigate its impact on the long-term functional status and quality of life (QOL), as compared to transfer to inpatient functional rehabilitation (IFR) resources. DESIGN An observational prospective cohort study. SETTING A single Level-1 specialized trauma center. PARTICIPANTS 213 individuals sustaining an AIS-D tSCI. INTERVENTIONS Home-based rehabilitation based on clinical specific criteria to be assessed by the acute care team. OUTCOME MEASURES Functional status and QOL as assessed by the Spinal Cord Independence Measure version 3 and WHOQOL-BREF questionnaire one year following the injury, respectively. RESULTS A total 37.9% of individuals fulfilled proposed criteria for home-based rehabilitation after acute care. As expected, this group was significantly younger, experienced lesser comorbidities and acute complications, and showed higher motor and sensory function compared to the IFR group. Home-rehabilitation was associated with a higher long-term functional status, physical and psychological QOL, when accounting for relevant confounding factors after an acute AIS-D tSCI. There was no readmission due to failure of home-based rehabilitation. CONCLUSION Home-based rehabilitation in selected individuals sustaining an acute AIS-D tSCI is a safe and interesting strategy to optimize the long-term outcome in terms of functional recovery, physical and psychological QOL, as well as to optimize inpatient rehabilitation resources. The proposed eligibility criteria can be used by the acute care team to select the optimal discharge orientation in this important subpopulation.
Collapse
Affiliation(s)
- Andréane Richard-Denis
- Department of medicine, Faculty of medicine, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche du CIUSSS Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montreal, Montreal, Québec, Canada
| | - Antoine Dionne
- Department of medicine, Faculty of medicine, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche du CIUSSS Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Pascal Mputu Mputu
- Department of medicine, Faculty of medicine, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche du CIUSSS Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Jean-Marc Mac-Thiong
- Centre de recherche du CIUSSS Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada
- Department of orthopaedic surgery, Faculty of medicine, Université de Montréal, Montreal, Quebec, Canada
- Sainte-Justine University Hospital Research Center, Montreal, Quebec, Canada
| |
Collapse
|
25
|
Difficulties capturing co-occurring traumatic brain injury among people with traumatic spinal cord injury: a population-based study. Spinal Cord 2023; 61:22-26. [PMID: 36114238 PMCID: PMC9836930 DOI: 10.1038/s41393-022-00851-5] [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: 02/10/2022] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 01/17/2023]
Abstract
STUDY DESIGN This is a population-based prospective cohort study. OBJECTIVES Traumatic brain injury (TBI) is common among people with traumatic spinal cord injury (TSCI), but rates vary across studies associated with variable approaches to diagnosis. We aimed to determine if a published diagnostic algorithm could be consistently applied to capture co-occurring TBI among persons sustaining TSCI. SETTING One of two spinal centres in New Zealand (NZ), the Burwood Spinal Unit (BSU) captures approximately 45% of NZ TSCI admissions. METHODS Adults (age 16+) with TSCI admitted to the BSU between 1 January 2021 and 31 August 2021 (n = 51) were included. Clinical notes were audited prospectively to identify co-occurring TBI. RESULTS We identified co-occurring TBI in 39% of TSCI cases with a small number of additional suspected TBI cases where TBI could not be confidently ruled in or out. Including all TBI cases, suspected or otherwise resulted in up to 55% of the sample having sustained co-occurring TBI. There were difficulties applying the published algorithm, associated with inconsistent documentation of TBI indicators from acute to rehabilitation contexts. CONCLUSIONS In this study, the feasibility of a TBI diagnostic algorithm for the TSCI population was low. Alternative approaches to screening for TBI among people sustaining TSCI are needed. Greater consistency in documenting TBI across the continuum of care will ensure TBI if present, is included in treatment planning.
Collapse
|
26
|
Does Wait Time During Acute Care for Transfer to Rehabilitation Admission Impact the Outcomes After a Traumatic Spinal Cord Injury?: A Retrospective Cohort Study. Am J Phys Med Rehabil 2022; 101:1122-1128. [PMID: 35213398 DOI: 10.1097/phm.0000000000001992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The objective of this study was to determine the impact of wait time in acute care for inpatient functional rehabilitation admission on the inpatient functional rehabilitation length of stay and functional outcome after a traumatic spinal cord injury. METHODS A retrospective cohort including 277 patients admitted to a single level 1 spinal cord injury acute care center was completed. Partial correlations were used between wait time (in days) for transfer to inpatient functional rehabilitation, the inpatient functional rehabilitation length of stay, and the Spinal Cord Independence Measure total score in the chronic period, adjusting for confounding variables. Stratified analyses were carried out based on the age group and severity of the injury. RESULTS Patients had to wait a mean of 7.3 ± 6.4 days (median = 6 days, interquartile range = 2-10 days, max = 29 days) for inpatient functional rehabilitation admission after rehabilitation readiness, which was not associated with the outcomes when adjusted ( P > 0.05). However, individuals 65 yrs or older with a motor-complete injury showed a lower functional status when exposed to wait time for transfer ( r = -0.87, P = 0.02). CONCLUSIONS Wait time up to 29 days may have no impact on the inpatient functional rehabilitation length of stay nor functional outcome after traumatic spinal cord injury. However, additional resources and/or prioritization should be considered for vulnerable subgroups.
Collapse
|
27
|
Cacioppo M, Menard H, Olivari Philiponnet C, Le Pabic E, Brochard C, Peyronnet B, Violas P, Riffaud L, Bonan I. Prevalence and risk factors for scoliosis in adults with closed and open spina bifida: A large, cross-sectional study. Ann Phys Rehabil Med 2022; 66:101685. [PMID: 35717001 DOI: 10.1016/j.rehab.2022.101685] [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: 11/16/2021] [Revised: 04/06/2022] [Accepted: 05/16/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Scoliosis develops in a proportion of children with myelomeningocele; however, little is known about scoliosis in adulthood and in other forms of spina bifida (SB). OBJECTIVES The aims of this study were to describe the prevalence of scoliosis and identify risk factors for its development in a large cohort of adults with open and closed SB. METHODS This was a cross-sectional study of data from 580 adults with SB attending their first consultation at a French multidisciplinary referral centre for SB. Sex, anatomical location and type of SB (open or closed), neurological level, back pain and ambulatory status (new Functional Ambulation Classification [new FAC]) were compared in adults with and without scoliosis. These characteristics were used to determine scoliosis risk factors. RESULTS In total, 331 adults fulfilled the inclusion criteria: 221 had open and 110 had closed SB. Of these, 176 (53%) had scoliosis: 57% open and 45% closed SB. As compared with individuals without scoliosis, those with scoliosis more frequently had open SB (p=0.03), more cranially located SB (p<0.0001), more severe neurological deficits (p≤0.02) and poorer walking ability (mean new FAC score 3.5 [SD 3.3] vs 6.1 [2.6], [p<0.0001]). In total, 69% had chronic back pain, with no difference in frequency between those with and without scoliosis. The odds of scoliosis was associated with asymmetrical motor level and a new FAC score <4 (odds ratio 0.46, p<0.006, and 0.75, p<0.0001, respectively). CONCLUSION About half of adults with open and closed SB had scoliosis. Back pain was frequent in those both with and without scoliosis. Individuals with low walking ability and an asymmetrical motor level should be monitored early and continuously to limit the consequences of scoliosis during their lifetime. A major issue is to determine how scoliosis evolves and to determine appropriate monitoring and treatment strategies for individuals at risk.
Collapse
Affiliation(s)
- Marine Cacioppo
- Department of Physical Medicine and Rehabilitation, Rennes University Hospital, Rennes 35033, France; Department of Physical Medicine and Rehabilitation, Brest University Hospital, 2 avenue Foch, Brest 29200, France; Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université Bretagne Occidentale, France; Department of Paediatric Physical Medicine and Rehabilitation, Ildys Foundation, Brest 29200, France.
| | - Hélène Menard
- Centre de référence maladies rares Spina Bifida, site constitutif du centre de référence C-MAVEM, CHU Rennes, Rennes 35000, France
| | - Camille Olivari Philiponnet
- Department of Physical Medicine and Rehabilitation, Rennes University Hospital, Rennes 35033, France; Centre de référence maladies rares Spina Bifida, site constitutif du centre de référence C-MAVEM, CHU Rennes, Rennes 35000, France
| | - Estelle Le Pabic
- CIC Inserm 1414. Clinical Data Centre, Rennes University Hospital, Rennes 35033, France
| | - Charlène Brochard
- Centre de référence maladies rares Spina Bifida, site constitutif du centre de référence C-MAVEM, CHU Rennes, Rennes 35000, France; Department of Gastro-enterology, Rennes University Hospital, Rennes 35033, France
| | - Benoit Peyronnet
- Centre de référence maladies rares Spina Bifida, site constitutif du centre de référence C-MAVEM, CHU Rennes, Rennes 35000, France; Department of Urology, Rennes University Hospital, Rennes 35033, France
| | - Philippe Violas
- Centre de référence maladies rares Spina Bifida, site constitutif du centre de référence C-MAVEM, CHU Rennes, Rennes 35000, France; Department of Orthopaedic Children surgery, Rennes University Hospital, Rennes 35033, France
| | - Laurent Riffaud
- Centre de référence maladies rares Spina Bifida, site constitutif du centre de référence C-MAVEM, CHU Rennes, Rennes 35000, France; Department of Neurosurgery, Rennes University Hospital, Rennes 35033, France; INSERM MediCIS, Unit U1099 LTSI, Rennes 1 University, Rennes, France
| | - Isabelle Bonan
- Department of Physical Medicine and Rehabilitation, Rennes University Hospital, Rennes 35033, France; Centre de référence maladies rares Spina Bifida, site constitutif du centre de référence C-MAVEM, CHU Rennes, Rennes 35000, France; Unité Empenn (ex-Visages) U1228 INSERM-INRIA, IRISA UMR CNRS 6074, Campus de Beaulieu, Rennes Cedex 35042, France
| |
Collapse
|
28
|
Solinsky R, Schleifer GD, Draghici AE, Hamner JW, Taylor JA. Methodologic implications for rehabilitation research: Differences in heart rate variability introduced by respiration. PM R 2022; 14:1483-1489. [PMID: 35077032 PMCID: PMC9309192 DOI: 10.1002/pmrj.12770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/09/2021] [Accepted: 01/07/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Heart rate variability is a measure of autonomic activity that is growing in popularity as a research outcome. However, despite its increased use, the known effects of respiration on heart rate variability measures are rarely accounted for in rehabilitation medicine research, leading to potential misinterpretation. OBJECTIVE To describe the effect that unpaced and paced breathing introduces to heart rate variability measures in a rehabilitation medicine relevant example of individuals with spinal cord injury. DESIGN Cross-sectional comparison of heart rate variability during unpaced and paced breathing (0.25 Hz, 15 breaths per minute) within the same individuals during the same lab session. SETTING Academic autonomic physiology laboratory. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Mean low frequency (LF) and high frequency (HF) heart rate variability power, percentage of total power derived from the LF spectrum, LF:HF ratio. RESULTS Fifty-nine individuals with spinal cord injury completed laboratory assessments using standardized protocols (NCT02139436). In repeated measures within individuals, mean LF power was significantly higher in unpaced breathing compared to paced breathing (1292 vs. 573 ms2 , p < .001). A Bland-Altman plot demonstrated significant positive proportional bias for LF power when comparing unpaced and paced breathing conditions (R2 = 0.39). Mean HF power was similar between unpaced and paced breathing conditions, although there were wide positive and negative differences between measures, leading to notable uncertainty when respiratory confounders were not accounted for. The percentages of total power derived from the LF spectrum and the mean LF:HF ratio were both significantly higher for unpaced breathing compared to paced breathing (64 vs. 42%, p < .001; and 3.2 vs. 1.1, p < .001, respectively). CONCLUSION Respiration has a significant effect on heart rate variability following spinal cord injury, and not accounting for this has serious consequences for accurate interpretation of unpaced data. Future studies of heart rate variability in rehabilitation medicine should accordingly consider paced breathing.
Collapse
Affiliation(s)
- Ryan Solinsky
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School
- Spaulding Research Institute, Boston, Massachusetts, USA
| | | | - Adina E Draghici
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School
- Spaulding Research Institute, Boston, Massachusetts, USA
| | - Jason W Hamner
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School
- Spaulding Research Institute, Boston, Massachusetts, USA
| | - J Andrew Taylor
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School
- Spaulding Research Institute, Boston, Massachusetts, USA
| |
Collapse
|
29
|
McRae J, Morgan S, Wallace E, Miles A. Oropharyngeal Dysphagia in Acute Cervical Spinal Cord Injury: A Literature Review. Dysphagia 2022:10.1007/s00455-022-10535-0. [DOI: 10.1007/s00455-022-10535-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022]
Abstract
AbstractDysphagia (swallowing impairment) is a frequent complication of cervical spinal cord injury (cSCI). Recently published national guidance in the UK on rehabilitation after traumatic injury confirmed that people with cSCI are at risk for dysphagia and require early evaluation while remaining nil by mouth [National Institute for Health and Care Excellence. Rehabilitation after traumatic injury (NG211), 2022, https://www.nice.org.uk/guidance/ng21]. While the pathogenesis and pathophysiology of dysphagia in cSCI remains unclear, numerous risk factors have been identified in the literature. This review aims to summarize the literature on the risk factors, presentation, assessment, and management of dysphagia in patients with cSCI. A bespoke approach to dysphagia management, that accounts for the multiple system impairment in cSCI, is presented; the overarching aim of which is to support effective management of dysphagia in patients with cSCI to prevent adverse clinical consequences.
Collapse
|
30
|
Limb accelerations during sleep are related to measures of strength, sensation, and spasticity among individuals with spinal cord injury. J Neuroeng Rehabil 2022; 19:118. [PMID: 36329467 PMCID: PMC9635075 DOI: 10.1186/s12984-022-01090-8] [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: 02/23/2022] [Accepted: 09/08/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To evaluate the relationship between measures of neuromuscular impairment and limb accelerations (LA) collected during sleep among individuals with chronic spinal cord injury (SCI) to provide evidence of construct and concurrent validity for LA as a clinically meaningful measure. METHODS The strength (lower extremity motor score), sensation (summed lower limb light touch scores), and spasticity (categorized lower limb Modified Ashworth Scale) were measured from 40 adults with chronic (≥ 1 year) SCI. Demographics, pain, sleep quality, and other covariate or confounding factors were measured using self-report questionnaires. Each participant then wore ActiGraph GT9X Link accelerometers on their ankles and wrist continuously for 1-5 days to measure LA from movements during sleep. Regression models with built-in feature selection were used to determine the most relevant LA features and the association to each measure of impairment. RESULTS LA features were related to measures of impairment with models explaining 69% and 73% of the variance (R²) in strength and sensation, respectively, and correctly classifying 81.6% (F1-score = 0.814) of the participants into spasticity categories. The most commonly selected LA features included measures of power and frequency (frequency domain), movement direction (correlation between axes), consistency between movements (relation to recent movements), and wavelet energy (signal characteristics). Rolling speed (change in angle of inclination) and movement smoothness (median crossings) were uniquely associated with strength. When LA features were included, an increase of 72% and 222% of the variance was explained for strength and sensation scores, respectively, and there was a 34% increase in spasticity classification accuracy compared to models containing only covariate features such as demographics, sleep quality, and pain. CONCLUSION LA features have shown evidence of having construct and concurrent validity, thus demonstrating that LA are a clinically-relevant measure related to lower limb strength, sensation, and spasticity after SCI. LA may be useful as a more detailed measure of impairment for applications such as clinical prediction models for ambulation.
Collapse
|
31
|
Sippel JL, Daly JE, Poggensee L, Ristau KD, Eberhart AC, Tam K, Evans CT, Lancaster B, Wickremasinghe IM, Burns SP, Goldstein B, Smith BM. Modernization of a Large Spinal Cord Injuries and Disorders Registry: The Veterans Administration Experience. Arch Rehabil Res Clin Transl 2022; 4:100237. [PMID: 36545529 PMCID: PMC9761267 DOI: 10.1016/j.arrct.2022.100237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Since the 1990s, Veterans Health Administration (VHA) has maintained a registry of Veterans with Spinal Cord Injuries and Disorders (SCI/Ds) to guide clinical care, policy, and research. Historically, methods for collecting and recording data for the VHA SCI/D Registry (VSR) have required significant time, cost, and staffing to maintain, were susceptible to missing data, and caused delays in aggregation and reporting. Each subsequent data collection method was aimed at improving these issues over the last several decades. This paper describes the development and validation of a case-finding and data-capture algorithm that uses primary clinical data, including diagnoses and utilization across 9 million VHA electronic medical records, to create a comprehensive registry of living and deceased Veterans seen for SCI/D services since 2012. A multi-step process was used to develop and validate a computer algorithm to create a comprehensive registry of Veterans with SCI/D whose records are maintained in the enterprise wide VHA Corporate Data Warehouse. Chart reviews and validity checks were used to validate the accuracy of cases that were identified using the new algorithm. An initial cohort of 28,202 living and deceased Veterans with SCI/D who were enrolled in VHA care from 10/1/2012 through 9/30/2017 was validated. Tables, reports, and charts using VSR data were developed to provide operational tools to study, predict, and improve targeted management and care for Veterans with SCI/Ds. The modernized VSR includes data on diagnoses, qualifying fiscal year, recent utilization, demographics, injury, and impairment for 38,022 Veterans as of 11/2/2022. This establishes the VSR as one of the largest ongoing longitudinal SCI/D datasets in North America and provides operational reports for VHA population health management and evidence-based rehabilitation. The VSR also comprises one of the only registries for individuals with non-traumatic SCI/Ds and holds potential to advance research and treatment for multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), and other motor neuron disorders with spinal cord involvement. Selected trends in VSR data indicate possible differences in the future lifelong care needs of Veterans with SCI/Ds. Future collaborative research using the VSR offers opportunities to contribute to knowledge and improve health care for people living with SCI/Ds.
Collapse
Key Words
- ALS, amyotrophic lateral sclerosis
- ARC, Allocation Resource Center
- ASIA, American Spinal Injury Association Impairment Scale
- Amyotrophic lateral sclerosis
- BI, Business Intelligence
- Big data
- CDW, Corporate Data Warehouse
- CPRS, computerized patient record system
- EMR, electronic medical record
- Electronic health records
- GUI, graphical user interface
- MIO, Management of Information & Outcomes
- MS, multiple sclerosis
- Medical informatics
- Motor neuron disease
- Multiple sclerosis
- Population health
- Population health management
- RHSCIR, Rick Hansen Spinal Cord Injury Registry
- Registries
- Rehabilitation
- SCD, spinal cord dysfunction
- SCI/D, Spinal Cord Injuries and Disorders
- SCIDO, Spinal Cord Injury and Disorders Outcomes
- SCIMS, Spinal Cord Injury Model Systems
- SME, subject matter expert
- Spinal cord injuries
- United States
- VHA, Veterans Health Administration
- VSR, VHA SCI/D Registry
- VSSC, VHA Service Support Center
- Veterans
- VistA, Veteran Health Information Systems and Technology Architecture
- WOC, Without Compensation
Collapse
Affiliation(s)
- Jennifer L. Sippel
- Spinal Cord Injuries & Disorders National Program Office (11 SCID), Veterans Health Administration, United States Department of Veterans Affairs, Washington, DC,Corresponding author Jennifer L. Sippel, PhD, Spinal Cord Injuries and Disorders (SCI/D) National Program Office (11SCID), Veterans Health Administration (VHA), 810 Vermont Ave NW, Washington, DC 20420.
| | - Jennifer E. Daly
- Spinal Cord Injuries & Disorders National Program Office (11 SCID), Veterans Health Administration, United States Department of Veterans Affairs, Washington, DC
| | - Linda Poggensee
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Health Care (CINCCH), Edward Hines Junior Hospital, Hines, IL
| | - Kim D. Ristau
- VHA Support Service Center (VSSC), Office of Analytics and Performance, Veterans Health Administration, Department of Veterans Affairs, Washington, DC
| | - Adam C. Eberhart
- Spinal Cord Injuries & Disorders National Program Office (11 SCID), Veterans Health Administration, United States Department of Veterans Affairs, Washington, DC
| | - Katharine Tam
- Spinal Cord Injury Service, John J. Cochran Veterans Hospital, Saint Louis, MO 63106
| | - Charlesnika T. Evans
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Health Care (CINCCH), Edward Hines Junior Hospital, Hines, IL,Center for Health Services and Outcomes Research and Department of Preventive Medicine, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Betsy Lancaster
- VHA Support Service Center (VSSC), Office of Analytics and Performance, Veterans Health Administration, Department of Veterans Affairs, Washington, DC
| | - I. Manosha Wickremasinghe
- Spinal Cord Injuries & Disorders National Program Office (11 SCID), Veterans Health Administration, United States Department of Veterans Affairs, Washington, DC
| | - Stephen P. Burns
- Spinal Cord Injury Service, VA Puget Sound Health Care System, Seattle, WA,Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
| | - Barry Goldstein
- Spinal Cord Injuries & Disorders National Program Office (11 SCID), Veterans Health Administration, United States Department of Veterans Affairs, Washington, DC,Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
| | - Bridget M. Smith
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Health Care (CINCCH), Edward Hines Junior Hospital, Hines, IL,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| |
Collapse
|
32
|
Arora T, Desai N, Kirshblum S, Chen R. Utility of transcranial magnetic stimulation in the assessment of spinal cord injury: Current status and future directions. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:1005111. [PMID: 36275924 PMCID: PMC9581184 DOI: 10.3389/fresc.2022.1005111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/16/2022] [Indexed: 11/06/2022]
Abstract
Comprehensive assessment following traumatic spinal cord injury (SCI) is needed to improve prognostication, advance the understanding of the neurophysiology and better targeting of clinical interventions. The International Standards for Neurological Classification of Spinal Cord Injury is the most common clinical examination recommended for use after a SCI. In addition, there are over 30 clinical assessment tools spanning across different domains of the International Classification of Functioning, Disability, and Health that have been validated and recommended for use in SCI. Most of these tools are subjective in nature, have limited value in predicting neurologic recovery, and do not provide insights into neurophysiological mechanisms. Transcranial magnetic stimulation (TMS) is a non-invasive neurophysiology technique that can supplement the clinical assessment in the domain of body structure and function during acute and chronic stages of SCI. TMS offers a better insight into neurophysiology and help in better detection of residual corticomotor connectivity following SCI compared to clinical assessment alone. TMS-based motor evoked potential and silent period duration allow study of excitatory and inhibitory mechanisms following SCI. Changes in muscle representations in form of displacement of TMS-based motor map center of gravity or changes in the map area can capture neuroplastic changes resulting from SCI or following rehabilitation. Paired-pulse TMS measures help understand the compensatory reorganization of the cortical circuits following SCI. In combination with peripheral stimulation, TMS can be used to study central motor conduction time and modulation of spinal reflexes, which can be used for advanced diagnostic and treatment purposes. To strengthen the utility of TMS in SCI assessment, future studies will need to standardize the assessment protocols, address population-specific concerns, and establish the psychometric properties of TMS-based measurements in the SCI population.
Collapse
Affiliation(s)
- Tarun Arora
- Krembil Research Institute, University Health Network, Toronto, ON, Canada,Correspondence: Tarun Arora Robert Chen
| | - Naaz Desai
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Steven Kirshblum
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States,Kessler Institute for Rehabilitation, West Orange, NJ, United States,Kessler Foundation, West Orange, NJ, United States,Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Robert Chen
- Krembil Research Institute, University Health Network, Toronto, ON, Canada,Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada,Division of Neurology, University of Toronto, Toronto, ON, Canada,Correspondence: Tarun Arora Robert Chen
| |
Collapse
|
33
|
Zegarek G, Tessitore E, Chaboudez E, Nouri A, Schaller K, Gondar R. SORG algorithm to predict 3- and 12-month survival in metastatic spinal disease: a cross-sectional population-based retrospective study. Acta Neurochir (Wien) 2022; 164:2627-2635. [PMID: 35925406 DOI: 10.1007/s00701-022-05322-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 07/17/2022] [Indexed: 01/26/2023]
Abstract
PURPOSE In this study, we wished to compare statistically the novel SORG algorithm in predicting survival in spine metastatic disease versus currently used methods. METHODS We recruited 40 patients with spinal metastatic disease who were operated at Geneva University Hospitals by the Neurosurgery or Orthopedic teams between the years of 2015 and 2020. We did an ROC analysis in order to determine the accuracy of the SORG ML algorithm and nomogram versus the Tokuhashi original and revised scores. RESULTS The analysis of data of our independent cohort shows a clear advantage in terms of predictive ability of the SORG ML algorithm and nomogram in comparison with the Tokuhashi scores. The SORG ML had an AUC of 0.87 for 90 days and 0.85 for 1 year. The SORG nomogram showed a predictive ability at 90 days and 1 year with AUCs of 0.87 and 0.76 respectively. These results showed excellent discriminative ability as compared with the Tokuhashi original score which achieved AUCs of 0.70 and 0.69 and the Tokuhashi revised score which had AUCs of 0.65 and 0.71 for 3 months and 1 year respectively. CONCLUSION The predictive ability of the SORG ML algorithm and nomogram was superior to currently used preoperative survival estimation scores for spinal metastatic disease.
Collapse
Affiliation(s)
- Gregory Zegarek
- Department of Neurosurgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.
| | - Enrico Tessitore
- Department of Neurosurgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Etienne Chaboudez
- Department of Neurosurgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Aria Nouri
- Department of Neurosurgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Karl Schaller
- Department of Neurosurgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Renato Gondar
- Department of Neurosurgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| |
Collapse
|
34
|
Development and validation of the sitting balance assessment for spinal cord injury (SitBASCI). Spinal Cord 2022; 60:826-830. [PMID: 35414698 DOI: 10.1038/s41393-022-00799-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 03/25/2022] [Accepted: 03/27/2022] [Indexed: 01/22/2023]
Abstract
STUDY DESIGN Multicentric psychometric study. OBJECTIVES The aim of this study is to introduce the development of the Sitting Balance Assessment for Spinal Cord Injury (SitBASCI) and assess its inter-rater reliability and internal consistency. SETTING The study was developed among the three Spinal Units of San Bortolo Hospital in Vicenza, Niguarda Hospital in Milan and AOU Careggi in Florence. METHODS SitBASCI is a 13-item scale developed to evaluate trunk control in individuals with SCI. Subjects were filmed while performing the 13 items of the scale. The videotapes were submitted to 25 examiners who evaluated patients' performances with the scale. The power of the study was estimated. The interclass correlational coefficient (ICC) was used to assess the inter-rater reliability of the examiner's evaluations regarding each item and the total. Cronbach's alpha was used to assess internal consistency of the scale and internal consistency of the scale on the eliminated item. RESULTS The study showed to have a significant power. The inter-rater reliability for the total score was ptot = 0.997 (item's values were p = 0.876-0.998). The internal consistency of the scale was alpha = 0.925, while the internal consistency of the scale on the eliminated item was alpha = 0.912-0.930. CONCLUSION SitBASCI had a high inter-rater reliability and internal consistency. Items had also good inter-rater reliability and item-total correlation. Therefore, SitBASCI could be proposed as a good and reliable instrument for Italian clinicians to evaluate sitting balance and trunk control in patient with SCI despite of aetiology and level of injury.
Collapse
|
35
|
Balthazaar SJ, Sengeløv M, Bartholdy K, Malmqvist L, Ballegaard M, Hansen B, Svendsen JH, Kruse A, Welling KL, Krassioukov AV, Biering-Sørensen F, Biering-Sørensen T. Cardiac arrhythmias six months following traumatic spinal cord injury. J Spinal Cord Med 2022; 45:631-637. [PMID: 34292114 PMCID: PMC9246248 DOI: 10.1080/10790268.2021.1950453] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To investigate the incidence of cardiac arrhythmias at six months following traumatic spinal cord injury (SCI) and to compare the prevalence of arrhythmias between participants with cervical and thoracic SCI. DESIGN A prospective observational study using continuous twenty-four-hour Holter monitoring. SETTING Inpatient rehabilitation unit of a university research hospital and patient home setting. PARTICIPANTS Fifty-five participants with acute traumatic SCI were prospectively included. For each participant, the SCI was characterized according to the International Standards for Neurological Classification of SCI by the neurological level and severity according to the American Spinal Injury Association Impairment Scale. OUTCOME MEASURES Comparisons between demographic characteristics and arrhythmogenic occurrences as early as possible after SCI (4 ± 2 days) followed by 1, 2, 3, 4 weeks and 6 month time points of Holter monitoring. RESULTS Bradycardia (heart rate [HR] <50 bpm) was present in 29% and 33% of the participants with cervical (C1-C8) and thoracic (T1-T12) SCI six months after SCI, respectively. The differences in episodes of bradycardia between the two groups were not significant (P < 0.54). The mean maximum HR increased significantly from 4 weeks to 6 months post-SCI (P < 0.001), however mean minimum and maximum HR were not significantly different between the groups at the six-month time point. There were no differences in many arrhythmias between recording periods or between groups at six months. CONCLUSIONS At the six-month timepoint following traumatic SCI, there were no significant differences in occurrences of arrhythmias between participants with cervical and thoracic SCI compared to the findings observed in the first month following SCI.
Collapse
Affiliation(s)
- Shane J.T. Balthazaar
- Department of Cardiology, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, British Columbia (BC), Canada
| | - Morten Sengeløv
- Clinic for Spinal Cord Injuries, Rigshospitalet, Copenhagen, Denmark,Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kim Bartholdy
- Clinic for Spinal Cord Injuries, Rigshospitalet, Copenhagen, Denmark
| | - Lasse Malmqvist
- Clinic for Spinal Cord Injuries, Rigshospitalet, Copenhagen, Denmark,Department of Clinical Neurophysiology, Rigshopitalet, Copenhagen, Denmark
| | - Martin Ballegaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,Department of Clinical Neurophysiology, Rigshopitalet, Copenhagen, Denmark,Department of Neurology, Zealand University Hospital at Roskilde, Roskilde, Denmark
| | - Birgitte Hansen
- Clinic for Spinal Cord Injuries, Rigshospitalet, Copenhagen, Denmark
| | - Jesper Hastrup Svendsen
- Clinic for Spinal Cord Injuries, Rigshospitalet, Copenhagen, Denmark,Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anders Kruse
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen, Denmark
| | | | - Andrei V. Krassioukov
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia (UBC), Vancouver, BC, Canada,Department of Medicine, Division of Physical Medicine and Rehabilitation, Vancouver, BC, Canada,Spinal Cord Program, GF Strong Rehabilitation Centre, University of British Columbia, Vancouver, BC, Canada
| | - Fin Biering-Sørensen
- Clinic for Spinal Cord Injuries, Rigshospitalet, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Clinic for Spinal Cord Injuries, Rigshospitalet, Copenhagen, Denmark,Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,Correspondence to: Tor Biering-Sørensen, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen; Cardiovascular Non-Invasive Imaging Research Laboratory Department of Cardiology, Herlev & Gentofte Hospital, Niels Andersensvej 65, DK-2900, Post 835, Copenhagen, Denmark.
| |
Collapse
|
36
|
de Los Reyes-Guzmán A, Fernández García L, Alvarez-Rodríguez M, Lozano-Berrio V, Domingo-García AM, Ceruelo-Abajo S. [Low-cost virtual reality. A new application for upper extremity motor rehabilitation in neurological pathology: Pilot study]. Rehabilitacion (Madr) 2022; 56:173-181. [PMID: 34511255 DOI: 10.1016/j.rh.2021.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/25/2021] [Accepted: 07/08/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study is to present a new virtual reality (VR) low cost application based on Leap Motion Controller (LMC) device for upper extremity motor rehabilitation after neurological pathology and to demonstrate its clinical feasibility by carrying out a pilot experience. MATERIAL AND METHODS The LMC allows the interaction with virtual applications by capturing the patient's hand movements. A pilot study was carried out with 4 patients with upper limb impairment reflected with Upper Extremity Motor Score (UEMS) greater than 10. They were assessed using the Box and Block (BBT) and the writing task within the Jebsen-Taylor Hand Function (JTHF) before and after the intervention. RESULTS All patients completed the 9-session, 30-min protocol divided into 3 sessions per week. They went from an average result of 38 (SD 20) blocks in BBT before the intervention to 44 (SD 21.72) after it. They went from 28.25 s (SD 8.61) to 26.75 s (SD 21.72) in the JTHF. Statistically significant differences were no found. The device usability was assessed by the QUEST scale, being the security, effectiveness and ease to use the aspects that patients considered to be a priority. CONCLUSIóN: A new VR development based on the LMC device is presented and the clinical feasibility of its application in neurological patients with upper limb involvement has been proven. A clinical study with a large sample size is needed to assess its potential clinical effectiveness as a treatment element.
Collapse
Affiliation(s)
| | - L Fernández García
- Servicio de Rehabilitación. Complejo Hospitalario Universitario de Toledo, Toledo, España
| | - M Alvarez-Rodríguez
- Unidad de Biomecánica. Hospital Nacional de Parapléjicos de Toledo, Toledo, España
| | - V Lozano-Berrio
- Unidad de Biomecánica. Hospital Nacional de Parapléjicos de Toledo, Toledo, España
| | - A M Domingo-García
- Unidad de Terapia Ocupacional. Hospital Nacional de Parapléjicos de Toledo, Toledo, España
| | - S Ceruelo-Abajo
- Servicio de Rehabilitación. Hospital Nacional de Parapléjicos de Toledo, Toledo, España
| |
Collapse
|
37
|
Gosálvez J, Vargas-Baquero E, López-Fernández C, Bartolomé-Nebreda J, Fernández JL, Johnston S. Sperm DNA damage in men with spinal cord injury: the relative incidence of single- and double-strand DNA breaks. Andrology 2022; 10:1292-1301. [PMID: 35716146 DOI: 10.1111/andr.13210] [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: 09/10/2021] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Men with spinal cord injury (SCI) show a high proportion of sperm DNA damage in their ejaculate but the underlying pathology remains elusive. OBJECTIVE To investigate the relative incidence of single (SSBs) and double-strand DNA breaks (DSBs) and DNase activity in men with SCI. MATERIALS AND METHODS This study included ejaculates of 20 men with SCI and 27 normozoospermic (sperm donors). A TwoTails comet assay (TTComet) allowed visualization of three categories of sperm DNA damage corresponding to SSBs, DSBs and those with a combination of SSBs and DSBs, facilitating accurate calculation of the total proportion of SSBs and DSBs. A subset of 15 individuals (sperm donors and SCI patients) was used to test for DNase activity in the seminal plasma. RESULTS While the proportion of DSBs in men with SCI (median-57.5%) was higher (P = 0.000) than normozoospermic samples (median-4.6%), the proportion of SSBs was higher (P = 0.022) in the normozoospermic ejaculates (median-6.0%) compared to men with SCI (median-2.5%). The relative proportion of the total DSBs with respect to the total SSBs was 3.3× in men with SCI but 0.9× in normozoospermic samples. We further confirmed the high DNase activity in the seminal plasma of men with SCI. DISCUSSION The TTComet assay provided new insights to the pathology of sperm DNA in men with SCI and may have diagnostic value in developing sperm selection methodologies to reduce DSBs prior to ART. CONCLUSION Men with SCI are characterized by a high proportion of sperm with DSBs and high levels of DNase activity in the seminal plasma compared to normozoospermic men.
Collapse
Affiliation(s)
- Jaime Gosálvez
- Unit of Genetics, Department of Biology, Universidad Autónoma de Madrid, Madrid, Spain
| | | | | | | | - José Luís Fernández
- INIBIC-Complexo Hospitalario Universitario A Coruña (CHUAC), Genetics Unit, Coruña, Spain
| | - Stephen Johnston
- School of Agriculture and Food Sciences, University of Queensland, Gatton, Australia
| |
Collapse
|
38
|
Spinal cord compression of neoplastic origin: surgical experience using a common clinical language. Clin Transl Oncol 2022; 24:1932-1939. [PMID: 35653005 DOI: 10.1007/s12094-022-02843-6] [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: 10/28/2021] [Accepted: 04/16/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess the value of a common clinical language in a multidisciplinary tumour board for spinal metastasis, using both the Rades score and the Spinal Instability Neoplastic Score (SINS) for multidisciplinary decision-making. METHODS Retrospective study of 60 consecutive patients treated surgically for MSCC. The indication for surgery was done in a multidisciplinary board, basically according to SINS and RADES scores. Three prognostic groups were defined according to the Rades score: poor (Rades 1: 20-30 points), intermediate (Rades 2: 31-35), and good (Rades 3: 36-45). RESULTS The 2-year overall survival (OS) rate was 50%, with median survival of 19 months. By Rades prognostic group (1, 2, 3), median OS was 6 months, 15 months, and not reached, respectively. OS rates at 6 months (Rades 1, 2, 3) were 51, 69, and 74.1%, respectively. Within the Rades 1 group, 6-month survival in patients with new-onset cancer was 68 vs. 40% in those with a known primary. The overall complication rate ≥ grade 3 was 23.3% (n = 14). In patients who underwent urgent surgery (< 48 h), the complication rate was 45.5% (5/11) versus 18.3% (9/49) in the planned surgeries. CONCLUSIONS Our findings supports the utility of using a common language in multidisciplinary tumour board for spinal metastasis. The 2-year OS rate in this series was 50%, which is the highest OS reported to date in this population. In the poor prognosis subgroup (Rades 1), OS at 6 months was higher in patients with new-onset cancer versus those with a known primary (68 vs. 40%). These findings suggest that surgery should be the first treatment option in patients with MSCC as first symptom of cancer although a predicted poor prognosis.
Collapse
|
39
|
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.
Collapse
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
| |
Collapse
|
40
|
Guo Y, Ge Y, Li J, Dou W, Pan Y. Impact of injury duration on a sensorimotor functional network in complete spinal cord injury. J Neurosci Res 2022; 100:1765-1774. [PMID: 35608180 PMCID: PMC9541761 DOI: 10.1002/jnr.25069] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 05/08/2022] [Accepted: 05/11/2022] [Indexed: 11/18/2022]
Abstract
Connectivity changes after spinal cord injury (SCI) appear as dynamic post‐injury procedures. The present study aimed to investigate the alterations in the functional connectivity (FC) in different injury duration in complete SCI using resting‐state functional magnetic resonance imaging (fMRI). A total of 30 healthy controls (HCs) and 27 complete SCI patients were recruited in this study. A seed‐based connectivity analysis compared FC differences between HCs and SCI and among SCI subgroups (SCI patients with post‐injury within 6 months (early stage, n = 13) vs. those with post‐injury beyond 6 months (late stage, n = 14)). Compared to HCs, SCI patients showed an increase in FC between sensorimotor cortex and cognitive, visual, and auditory cortices. The FC between motor cortex and cognitive cortex increased over time after injury. The FC between sensory cortex and visual cortex increased within 6 months after SCI, while FC between the sensory cortex and auditory cortex increased beyond 6 months after injury. The FC between sensorimotor cortex and cognitive, visual, auditory regions increased in complete SCI patients. The brain FC changed dynamically, and rehabilitation might be adapted over time after SCI.
Collapse
Affiliation(s)
- Yun Guo
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, Beijing, China.,School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yunxiang Ge
- Department of Electronic Engineering, Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing, China
| | - Jianjun Li
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China.,Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center, Beijing, China
| | - Weibei Dou
- Department of Electronic Engineering, Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing, China
| | - Yu Pan
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, Beijing, China.,School of Clinical Medicine, Tsinghua University, Beijing, China
| |
Collapse
|
41
|
Development of the International Spinal Cord Injury Basic Data Set for informal caregivers. Spinal Cord 2022; 60:888-894. [PMID: 35581401 PMCID: PMC9110939 DOI: 10.1038/s41393-022-00810-0] [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: 09/20/2021] [Revised: 05/05/2022] [Accepted: 05/08/2022] [Indexed: 11/09/2022]
Abstract
Study design Mixed-methods, including expert consensus for initial development and a multi-center repeated measures design for field testing. Objectives To develop an International Spinal Cord Injury Basic Data Set for caregivers of individuals with spinal cord injury/disorder (SCI/D) for use in research and clinical care settings. Setting International, multi-disciplinary working group with field testing in five North American pediatric rehabilitation hospitals. Methods The data set was developed iteratively through meetings and online surveys with a working group of experts in pediatric and adult SCI/D rehabilitation and caregivers of individuals with SCI/D. Initial reliability was examined through repeat administration of a beta form with a sample of caregivers recruited by convenience. The sample was characterized with descriptive statistics. Intra-rater reliability of variables was assessed using Intra-Class Correlations. Results The beta test form included 27 items, covering 3 domains: (1) demographic information for persons providing care; (2) caregiver’s allocation of time and satisfaction; and (3) perceived burden of caregiving. Thirty-nine caregivers completed both administrations. Mean time for completion was 10 min. There was moderate to excellent reliability for the majority of variables, but results indicated necessary revisions to improve reliability and decrease respondent burden. The final version of the data form contains 7 items and is intended for self-administration among informal caregivers of individuals with SCI/D across the lifespan. Conclusions The International SCI Basic Data Set for Informal Caregivers can be used to standardize data collection and reporting about informal caregivers for individuals with SCI/D to advance our understanding of this population and the data form has additional utility to screen for caregiver needs in clinical settings.
Collapse
|
42
|
Meyer HS, Wagner A, Raufer A, Joerger AK, Gempt J, Meyer B. Surgery in Acute Metastatic Spinal Cord Compression: Timing and Functional Outcome. Cancers (Basel) 2022; 14:cancers14092249. [PMID: 35565376 PMCID: PMC9099617 DOI: 10.3390/cancers14092249] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Spinal metastases affect an exceptionally high number of cancer patients and thereby represent a common challenge for healthcare providers. Patients may suffer from debilitating symptoms, including excruciating back pain, immobility and even neurological dysfunction. An exceptionally acute clinical presentation is caused by the compression of the spinal cord through growth of a spinal metastasis within the spinal canal, which may leave the patient with acute spinal cord injury in need of rapid surgical treatment. In clinical practice and science, no true timeframe has yet been defined within which these patients need to undergo surgery, although it is generally understood that their recovery and functional rehabilitation correlate with the time to surgery after symptom onset. In our study, we analyzed a surgically treated cohort of patients with acute spinal cord injury by metastatic compression to investigate the correlation of the timing of surgery with neurological recovery. We were able to identify a subgroup of patients with significantly improved recovery, in whom surgery was initiated within 16 h after admission. Complication rates were not significantly more frequent in this subgroup compared to patients operated on after 16 h. Based on these findings, we conclude that striving for surgery as early as feasible is a warranted strategy in patients with acute neurological deterioration due to metastatic spinal cord compression. Abstract Background: Patients with metastatic spinal cord compression (MSCC) may experience long-term functional impairment. It has been established that surgical decompression improves neurological outcomes, but the effect of early surgery remains uncertain. Our objective was to evaluate the impact of early versus late surgery for acute MSCC due to spinal metastases (SM). Methods: We retrospectively reviewed a consecutive cohort of all patients undergoing surgery for SMs at our institution. We determined the prevalence of acute MSCC; the time between acute neurological deterioration as well as between admission and surgery (standard procedure: decompression and instrumentation); and neurological impairment graded by the ASIA scale upon presentation and discharge. Results: We screened 693 patients with surgery for spinal metastasis; 140 patients (21.7%) had acute MSCC, defined as neurological impairment corresponding to ASIA grade D or lower, acquired within 72 h before admission. Non-MSCC patients had surgery for SM-related cauda equina syndrome, radiculopathy and/or spinal instability. Most common locations of the SM in acute MSCC were the thoracic (77.9%) and cervical (10.7%) spine. Per standard of care, acute MSCC patients underwent surgery including decompression and instrumentation, and the median time from admission to surgery was 16 h (interquartile range 10–22 h). Within the group of patients with acute MSCC, those who underwent early surgery (i.e., before the median 16 h) had a significantly higher rate of ASIA improvement by at least one grade at discharge (26.5%) compared to those who had late surgery after 16 h (10.1%; p = 0.024). Except for a significantly higher sepsis rate in the late surgery group, complication rates did not differ between the late and early surgery subgroups. Conclusions: We report data on the largest cohort of patients with MSCC to date. Early surgery is pivotal in acute MSCC, substantially increasing the chance for neurological improvement without increasing complication rates. We found no significant impact when surgery was performed later than 24 h after admission. These findings will provide the framework for a much-needed prospective study. Until then, the treatment strategy should entail the earliest possible surgical intervention.
Collapse
Affiliation(s)
- Hanno S. Meyer
- Correspondence: ; Tel.: +49-89-4140-2151; Fax: +49-89-4140-4889
| | | | | | | | | | | |
Collapse
|
43
|
Solinsky R, Betancourt L, Schmidt-Read M, Kupfer M, Owens M, Schwab JM, Dusseau NB, Szlachcic Y, Sutherland L, Taylor JA, Nash MS. Acute Spinal Cord Injury Is Associated With Prevalent Cardiometabolic Risk Factors. Arch Phys Med Rehabil 2022; 103:696-701. [PMID: 34062117 DOI: 10.1016/j.apmr.2021.04.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/29/2021] [Accepted: 04/26/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To (1) describe the prevalence of cardiometabolic disease (CMD) at spinal cord injury (SCI) rehabilitation discharge; (2) compare this with controls without SCI; and (3) identify factors associated with increased CMD. DESIGN Multicenter, prospective observational study. SETTING Five National Institute on Disability, Independent Living, and Rehabilitation Research Model SCI Rehabilitation Centers. PARTICIPANTS SCI (n=95): patients aged 18-70 years, with SCI (neurologic levels of injury C2-L2, American Spinal Injury Association Impairment Scale grades A-D), and enrolled within 2 months of initial rehabilitation discharge. Control group (n=1609): age/sex/body mass index-matched entries in the National Health and Nutrition Examination Education Survey (2016-2019) (N=1704). INTERVENTIONS None MAIN OUTCOME MEASURES: Percentage of participants with SCI with CMD diagnosis, prevalence of CMD determinants within 2 months of rehabilitation discharge, and other significant early risk associations were analyzed using age, sex, body mass index, insulin resistance (IR) by fasting glucose and Homeostasis Model Assessment (v.2), fasting triglycerides, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol, total cholesterol, and resting blood pressure (systolic and diastolic). RESULTS Participants with SCI had significantly higher diastolic blood pressure and triglycerides than those without SCI, with lower fasting glucose and HDL-C. A total of 74.0% of participants with SCI vs 38.5% of those without SCI were obese when applying population-specific criteria (P<.05). Low HDL-C was measured in 54.2% of participants with SCI vs 15.4% of those without (P<.05). IR was not significantly different between groups. A total of 31.6% of participants with SCI had ≥3 CMD determinants, which was 40.7% higher than those without SCI (P<.05). Interplay of lipids and lipoproteins (ie, total cholesterol:HDL-C ratio and triglyceride:HDL-C ratio) were associated with elevated risk in participants with SCI for myocardial infarction and stroke. The only significant variable associated with CMD was age (P<.05). CONCLUSIONS Individuals with SCI have an increased CMD risk compared with the general population; obesity, IR, and low HDL-C are the most common CMD risk determinants; age is significantly associated with early CMD.
Collapse
Affiliation(s)
| | - Luisa Betancourt
- The Miami Project to Cure Paralysis-University of Miami Miller School of Medicine, Miami, FL
| | - Mary Schmidt-Read
- Thomas Jefferson University Hospital and Magee Rehabilitation Hospital, Philadelphia PA
| | - Mendel Kupfer
- Thomas Jefferson University Hospital and Magee Rehabilitation Hospital, Philadelphia PA
| | - Marilyn Owens
- Thomas Jefferson University Hospital and Magee Rehabilitation Hospital, Philadelphia PA
| | - Jan M Schwab
- Belford Center for Spinal Cord Injury, The Ohio State University, Wexner Medical Center, Columbus, OH; Spinal Cord Injury Medicine, Department of Neurology, The Ohio State University, Wexner Medical Center, Columbus, OH; Department of Physical Medicine and Rehabilitation, The Ohio State University, Wexner Medical Center, Columbus, OH
| | - Nathaniel B Dusseau
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Wexner Medical Center, Columbus, OH
| | - Yaga Szlachcic
- Southern California Spinal Cord Injury Model System, Downey, CA; Rancho Research Institute at Rancho Los Amigos National Rehabilitation Center, Downey, CA
| | - Linda Sutherland
- Rancho Research Institute at Rancho Los Amigos National Rehabilitation Center, Downey, CA
| | | | - Mark S Nash
- The Miami Project to Cure Paralysis-University of Miami Miller School of Medicine, Miami, FL.
| |
Collapse
|
44
|
Orthostatic systemic and cerebral hemodynamics in newly injured patients with spinal cord injury. Auton Neurosci 2022; 240:102973. [DOI: 10.1016/j.autneu.2022.102973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 02/25/2022] [Accepted: 03/14/2022] [Indexed: 11/23/2022]
|
45
|
Wick J, Le H, Wick K, Peddada K, Bacon A, Han G, Carroll T, Swinford S, Javidan Y, Roberto R, Martin A, Ebinu J, Kim K, Klineberg E. Patient Characteristics, Injury Types, and Costs Associated with Secondary Over-Triage of Isolated Cervical Spine Fractures. Spine (Phila Pa 1976) 2022; 47:414-422. [PMID: 34366413 DOI: 10.1097/brs.0000000000004190] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To aim of this study was to identify patient variables, injury characteristics, and costs associated with operative and non-operative treatment following inter-facility transfer of patients with isolated cervical spine fractures. SUMMARY OF BACKGROUND DATA Patients with isolated cervical spine fractures are subject to inter-facility transfer for surgical assessment, yet are often treated nonoperatively. The American College of Surgeons' benchmark rate of "secondary over-triage" is <50%. Identifying patient and injury characteristics as well as costs associated with treatment following transfer of patients with isolated cervical spine fractures may help reduce rates of secondary over-triage and healthcare expenditures. METHODS Patients transferred to a Level-1 trauma center with isolated cervical spine fractures between January 2015 and September 2020 were identified. Patient demographics, comorbidities, insurance data, injury characteristics, imaging workup, treatment, and financial data were collected for all patients. Multivariable logistic regression models were constructed to identify patient and injury characteristics associated with surgical treatment. RESULTS Nearly 75% of patients were treated non-operatively. Over 97% of transfers were accepted by the general surgery trauma service. Multivariable modeling found that higher BMI, presence of any neurologic deficit including spinal cord or isolated spinal nerve root injuries, present smoking status, or cervical spine magnetic resonance imaging obtained post-transfer, were associated with surgical treatment for isolated cervical spine fractures. Among patients with type II dens fractures, increased fracture displacement was associated with surgical treatment. Median charges to patients treated operatively and nonoperatively were $380,890 and $90,734, respectively. Median hospital expenditures for patients treated operatively and nonoperatively were $55,115 and $12,131, respectively. CONCLUSION A large proportion of patients with isolated cervical spine fractures are subject to over-triage. Injury characteristics are important for determining need for surgical treatment, and therefore interfacility transfer. Improving communication with spine surgeons when deciding to transfer patients may significantly reduce health care costs and resource use.Level of Evidence: 4.
Collapse
Affiliation(s)
- Joseph Wick
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Hai Le
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Katherine Wick
- Department of Internal Medicine, University of California Davis Medical Center, Sacramento, CA
| | - Kranti Peddada
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Adam Bacon
- University of California Davis School of Medicine, Sacramento, CA
| | - Gloria Han
- University of California Davis School of Medicine, Sacramento, CA
| | - Trevor Carroll
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Steven Swinford
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Yashar Javidan
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Rolando Roberto
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Allan Martin
- Department of Neurological Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Julius Ebinu
- Department of Neurological Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Kee Kim
- Department of Neurological Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Eric Klineberg
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA
| |
Collapse
|
46
|
Activity-dependent spinal cord neuromodulation rapidly restores trunk and leg motor functions after complete paralysis. Nat Med 2022; 28:260-271. [PMID: 35132264 DOI: 10.1038/s41591-021-01663-5] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 12/16/2021] [Indexed: 12/15/2022]
Abstract
Epidural electrical stimulation (EES) targeting the dorsal roots of lumbosacral segments restores walking in people with spinal cord injury (SCI). However, EES is delivered with multielectrode paddle leads that were originally designed to target the dorsal column of the spinal cord. Here, we hypothesized that an arrangement of electrodes targeting the ensemble of dorsal roots involved in leg and trunk movements would result in superior efficacy, restoring more diverse motor activities after the most severe SCI. To test this hypothesis, we established a computational framework that informed the optimal arrangement of electrodes on a new paddle lead and guided its neurosurgical positioning. We also developed software supporting the rapid configuration of activity-specific stimulation programs that reproduced the natural activation of motor neurons underlying each activity. We tested these neurotechnologies in three individuals with complete sensorimotor paralysis as part of an ongoing clinical trial ( www.clinicaltrials.gov identifier NCT02936453). Within a single day, activity-specific stimulation programs enabled these three individuals to stand, walk, cycle, swim and control trunk movements. Neurorehabilitation mediated sufficient improvement to restore these activities in community settings, opening a realistic path to support everyday mobility with EES in people with SCI.
Collapse
|
47
|
David G, Vallotton K, Hupp M, Curt A, Freund P, Seif M. Extent of cord pathology in the lumbosacral enlargement in non-traumatic versus traumatic spinal cord injury. J Neurotrauma 2022; 39:639-650. [PMID: 35018824 DOI: 10.1089/neu.2021.0389] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study compares remote neurodegenerative changes caudal to a cervical injury in degenerative cervical myelopathy (DCM) (i.e., non-traumatic) and incomplete traumatic spinal cord injury (tSCI) patients, using MRI-based tissue area measurements and diffusion tensor imaging (DTI). Eighteen mild to moderate DCM patients with sensory impairments (mJOA score: 16.2±1.9), 14 incomplete tetraplegic tSCI patients (AIS C&D), and 20 healthy controls were recruited. All participants received DTI and T2*-weighted scans in the lumbosacral enlargement (caudal to injury) and at C2/C3 (rostral to injury). MRI readouts included DTI metrics in the white matter (WM) columns and cross-sectional WM and gray matter area. One-way ANOVA with Tukey's post-hoc comparison (p<0.05) was used to assess group differences. In the lumbosacral enlargement, compared to DCM, tSCI patients exhibited decreased fractional anisotropy in the lateral (tSCI vs. DCM, -11.9%, p=0.007) and ventral WM column (-8.0%, p=0.021), and showed trend toward lower values in the dorsal column (-8.9%, p=0.068). At C2/C3, compared to controls, fractional anisotropy was lower in both groups in the dorsal (DCM vs. controls, -7.9%, p=0.024; tSCI vs. controls, -10.0%, p=0.007) and in the lateral column (DCM: -6.2%, p=0.039; tSCI: -13.3%, p<0.001), while tSCI patients had lower fractional anisotropy than DCM patients in the lateral column (-7.6%, p=0.029). WM areas were not different between patient groups but were lower compared to controls in the lumbosacral enlargement (DCM: -16.9%, p<0.001; tSCI, -10.5%, p=0.043) and at C2/C3 (DCM: -16.0%, p<0.001; tSCI: -18.1%, p<0.001). In conclusion, mild to moderate DCM and incomplete tSCI lead to similar degree of degeneration of the dorsal and lateral columns at C2/C3, but tSCI results in more widespread white matter damage in the lumbosacral enlargement. These remote changes are likely to contribute to the patients' impairment and recovery. DTI is a sensitive tool to assess remote pathological changes in DCM and tSCI patients.
Collapse
Affiliation(s)
- Gergely David
- University of Zurich, Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland.,University Medical Center Hamburg-Eppendorf, 37734, Department of Systems Neuroscience, Hamburg, Germany;
| | - Kevin Vallotton
- University of Zurich, Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland;
| | - Markus Hupp
- University of Zurich, 27217, Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland;
| | - Armin Curt
- University of Zurich, 27217, Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland;
| | - Patrick Freund
- University of Zurich, 27217, Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland.,UCL Institute of Neurology, 61554, Department of Brain Repair and Rehabilitation, London, United Kingdom of Great Britain and Northern Ireland.,UCL Institute of Neurology, 61554, Wellcome Trust Centre for Neuroimaging, London, United Kingdom of Great Britain and Northern Ireland.,Max Planck Institute for Human Cognitive and Brain Sciences, 27184, Department of Neurophysics, Leipzig, Germany;
| | - Maryam Seif
- University of Zurich, 27217, Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland.,Max Planck Institute for Human Cognitive and Brain Sciences, 27184, Leipzig, Department of Neurophysics, Germany;
| |
Collapse
|
48
|
Lee SW, Lim KB, Kim J, Lee H, Kim HS, Yoo J. Concordance between the international standards for neurological classification of spinal cord injury motor examination and needle electromyography findings in muscles with a motor power grade of zero or trace. J Spinal Cord Med 2022; 46:433-440. [PMID: 35007492 PMCID: PMC10114965 DOI: 10.1080/10790268.2021.2021044] [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] [Indexed: 10/19/2022] Open
Abstract
CONTEXT/OBJECTIVE To evaluate the accuracy of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) motor examination in individuals with spinal cord injury (SCI) with motor grade 0 or 1 and analyze its degree of concordance with needle electromyography (EMG) findings for each key muscle. DESIGN Retrospective study. SETTING University hospital in Goyang, Korea. PARTICIPANTS Individuals with SCI admitted to the Department of Rehabilitation from January 2013 to June 2019. INTERVENTIONS In the enrolled persons, needle EMG was performed on muscles with motor grade 0 or 1 on ISNCSCI examination, and muscle contraction was confirmed through the detection of motor unit action potential. OUTCOME MEASURES The agreement between motor examination and needle EMG findings was analyzed. RESULTS In 175 key muscles, needle EMG findings in 115 and 60 muscles evaluated as grades 0 and 1 on ISNCSCI examination showed 80% and 50% agreements, respectively. We found a fair agreement between motor examination and needle EMG findings (κ = 0.309, P < 0.0001). Moreover, statistically significant agreement was seen only in T1, L2, and S1 key muscles (κ = 1, P < 0.0001; κ = 0.359, P = 0.019; and κ = 0.521, P = 0.004, respectively). CONCLUSIONS It is important to accurately distinguish between grade 0 and 1 motor power to maximize the positive outcomes from rehabilitation treatment and predict the possibility of recovery in individuals with SCI. Therefore, to improve the accuracy of motor examination and the American Spinal Injury Association Impairment Scale, needle EMG confirmation could be considered for muscles with motor grade 0 or 1 in individuals with SCI.
Collapse
Affiliation(s)
- Sang Wan Lee
- Department of Physical Medicine and Rehabilitation, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea
| | - Kil-Byung Lim
- Department of Physical Medicine and Rehabilitation, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea
| | - Jiyong Kim
- Department of Physical Medicine and Rehabilitation, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea
| | - Hojin Lee
- Department of Physical Medicine and Rehabilitation, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea
| | - Ha Seong Kim
- Department of Physical Medicine and Rehabilitation, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea
| | - Jeehyun Yoo
- Department of Physical Medicine and Rehabilitation, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea
| |
Collapse
|
49
|
Karamian BA, Siegel N, Nourie B, Serruya MD, Heary RF, Harrop JS, Vaccaro AR. The role of electrical stimulation for rehabilitation and regeneration after spinal cord injury. J Orthop Traumatol 2022; 23:2. [PMID: 34989884 PMCID: PMC8738840 DOI: 10.1186/s10195-021-00623-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 12/27/2021] [Indexed: 12/26/2022] Open
Abstract
Electrical stimulation is used to elicit muscle contraction and can be utilized for neurorehabilitation following spinal cord injury when paired with voluntary motor training. This technology is now an important therapeutic intervention that results in improvement in motor function in patients with spinal cord injuries. The purpose of this review is to summarize the various forms of electrical stimulation technology that exist and their applications. Furthermore, this paper addresses the potential future of the technology.
Collapse
Affiliation(s)
- Brian A Karamian
- Rothman Orthopaedic Institute at Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA.
| | - Nicholas Siegel
- Rothman Orthopaedic Institute at Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
| | - Blake Nourie
- Rothman Orthopaedic Institute at Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
| | | | - Robert F Heary
- Department of Neurological Surgery, Hackensack Meridian School of Medicine, Nutley, NJ, 07110, USA
| | - James S Harrop
- Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Alexander R Vaccaro
- Rothman Orthopaedic Institute at Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
| |
Collapse
|
50
|
Dent K, Zebracki K, Sadowsky C, Martin R, Behrman A, Lipa B, Biering-Sørensen F, Vogel LC, Mulcahey MJ. Evaluation of the International Spinal Cord Injury Bowel Function Basic Data Set Version 2.0 in Children and Youth With Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2022; 28:21-33. [PMID: 35145332 PMCID: PMC8791417 DOI: 10.46292/sci19-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To establish the utility and feasibility of the International Spinal Cord Injury/Dysfunction (SCI/D) Bowel Function Basic Data Set Version 2.0 in pediatric SCI populations. METHODS This was a noninterventional, repeated measure design conducted in Pennsylvania, Maryland, Illinois, Kentucky, and South Carolina. The International Spinal Cord Injury/Dysfunction (SCI/D) Bowel Function Basic Data Set Version 2.0 was administered repeatedly, twice at the point of care and once over the phone. Time to complete the data set was recorded. Inter- and intrarater reliability was examined by intraclass correlation coefficients (ICC) with 95% confidence intervals (CI), and agreement between the bowel function basic data set variables and medical records was calculated using percentages. Intrarater reliability involved the same person administering the data once at the point of care and once over the phone. RESULTS Forty-one children/youth ages 1 to 20 years participated in this study. Average time to complete the data set was 5.17 minutes. Interrater reliability was good to excellent (ICC ≥ 0.75) for most variables. Five variables had moderate interrater reliability (ICC = 0.05-0.74) and three had poor interrater reliability (ICC < 0.05). With the exception of one variable that had poor intrarater reliability (constipating agent, ICC = 0.00) and one that approached moderate reliability (digital evacuation, ICC = 0.74), intrarater reliability was good to strong for every bowel variable (ICC = 0.88-1.00). Only 12 (32%) medical records had explicit documentation of one or more of the variables on the Basic Bowel Function Basic Data Set V2.0. CONCLUSION The results support future research with a larger and more diverse sample of children with SCI to build upon the psychometric work described herein.
Collapse
Affiliation(s)
- Kathryn Dent
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Cristina Sadowsky
- International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, Maryland
,Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Rebecca Martin
- International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, Maryland
| | - Andrea Behrman
- Department of Neurosurgery, Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky
| | - Bethany Lipa
- Shriners Hospitals for Children, Philadelphia, Pennsylvania
| | - Fin Biering-Sørensen
- Section for Spinal Cord Injuries, Department for Brain and Spinal Cord Injuries, Rigshospitalet, HornBaek, Denmark
,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - MJ Mulcahey
- Center for Outcomes and Measurement & Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania
| |
Collapse
|