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Wu KPH, Lin LC, Lu JCY. Application of Supercharge End-to-Side (SETS) Obturator to Femoral Nerve Transfer in Electrical Injury-Induced Neuropathy to Improve Knee Extension. Arch Plast Surg 2022; 49:769-772. [PMCID: PMC9747276 DOI: 10.1055/s-0042-1756290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/17/2022] [Indexed: 12/15/2022] Open
Abstract
Femoral nerve injuries are devastating injuries that lead to paralysis of the quadriceps muscles, weakening knee extension to prohibit ambulation. We report a devastating case of electrical injury-induced femoral neuropathy, where no apparent site of nerve disruption can be identified, thus inhibiting the traditional choices of nerve reconstruction such as nerve repair, grafting, or transfer. Concomitant spinal cord injury resulted in spastic myopathy of the antagonist muscles that further restricted knee extension. Our strategy was to perform (1) supercharge end-to-side technique (SETS) to augment the function of target muscles and (2) fractional tendon lengthening to release the spastic muscles. Dramatic postoperative improvement in passive and active range of motion highlights the effectiveness of this strategy to manage partial femoral nerve injuries.
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Affiliation(s)
- Katie Pei-Hsuan Wu
- Department of Physical Medicine and Rehabilitation, Chang Gung Medical University, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan
| | - Li-Ching Lin
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Medical University, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Johnny Chuieng-Yi Lu
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Medical University, Chang Gung Memorial Hospital, Linkou, Taiwan,Address for correspondence Johnny Chuieng-Yi Lu, MD, MS Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung University, Chang Gung Memorial Hospital5 Fu-Hsing Street, Kuei-Shan, Taoyuan 333Taiwan
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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.
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Zarkou A, Field-Fote EC. The influence of physiologic and atmospheric variables on spasticity after spinal cord injury. NeuroRehabilitation 2021; 48:353-363. [PMID: 33814472 DOI: 10.3233/nre-201625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A number of physiological and atmospheric variables are believed to increase spasticity in persons with spinal cord injury (SCI) based on self-reported measures, however, there is limited objective evidence about the influence of these variables on spasticity. OBJECTIVE We investigated the relationship between physiological/ atmospheric variables and level of spasticity in individuals with SCI. METHODS In 53 participants with motor-incomplete SCI, we assessed the influence of age, time since injury, sex, injury severity, neurological level of injury, ability to walk, antispasmodic medication use, temperature, humidity, and barometric pressure on quadriceps spasticity. Spasticity was assessed using the pendulum test first swing excursion (FSE). To categorize participants based on spasticity severity, we performed cluster analysis. We used multivariate stepwise regression to determine variables associated with spasticity severity level. RESULTS Three spasticity groups were identified based on spasticity severity level: low, moderate, and high. The regression analysis revealed that only walking ability and temperature were significantly related to spasticity severity. CONCLUSIONS These outcomes validate the self-reported perception of people with SCI that low temperatures worsen spasticity. The findings refine prior evidence that people with motor-incomplete SCI have higher levels of spasticity, showing that those with sufficient motor function to walk have the highest levels of spasticity.
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Affiliation(s)
- Anastasia Zarkou
- Spinal Cord Injury Research Laboratory, Crawford Research Institute, Shepherd Center, Atlanta, GA, USA
| | - Edelle C Field-Fote
- Spinal Cord Injury Research Laboratory, Crawford Research Institute, Shepherd Center, Atlanta, GA, USA.,Division of Physical Therapy, School of Medicine, Emory University, Atlanta, GA, USA.,Program in Applied Physiology, School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
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Field-Fote EC, Furbish CL, Tripp NE, Zanca JM, Dyson-Hudson T, Kirshblum S, Heinemann AW, Chen D, Felix ER, Worobey L, Schmidt-Read M, Marino RJ, Hayat MJ. Characterizing the Experience of Spasticity after Spinal Cord Injury: A National Survey Project of the Spinal Cord Injury Model Systems Centers. Arch Phys Med Rehabil 2021; 103:764-772.e2. [PMID: 34015348 DOI: 10.1016/j.apmr.2021.03.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/14/2021] [Accepted: 03/23/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To characterize the qualities that individuals with spinal cord injury (SCI) associate with their experience of spasticity and to describe the relationship between spasticity and perceived quality of life and the perceived value of spasticity management approaches. DESIGN Online cross-sectional survey. SETTING Multicenter collaboration among 6 Spinal Cord Injury Model Systems hospitals in the United States. PARTICIPANTS Individuals with SCI (N=1076). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Qualities of Spasticity Questionnaire, modified Spinal Cord Injury-Spasticity Evaluation Tool (mSCI-SET), and the modified Patient-Reported Impact of Spasticity Measure (mPRISM). RESULTS Respondents indicated that spasms most often occurred in response to movement-related triggering events. However, spontaneous spasms (ie, no triggering event) were also reported to be among the most common types. Frequency of spasms appears to decline with age. The highest frequency of spasms was reported by 56% of respondents aged <25 years and by only 28% of those >55 years. Stiffness associated with spasticity was reported to be more common than spasms (legs, 65% vs 54%; trunk, 33% vs 18%; arms, 26% vs 15%). Respondents reported negative effects of spasticity more commonly than positive effects. Based on their association with negative scores on the mSCI-SET and the mPRISM, the 5 most problematic experiences reported were stiffness all day, interference with sleep, painful spasms, perceived link between spasticity and pain, and intensification of pain before a spasm. Respondents indicated spasticity was improved more by stretching (48%) and exercise (45%) than by antispasmodics (38%). CONCLUSIONS The experience of spasticity after SCI is complex and multidimensional, with consequences that affect mobility, sleep, comfort, and quality of life. Stiffness, rather than spasms, appears to be the most problematic characteristic of spasticity. Physical therapeutic interventions to treat spasticity warrant in-depth investigation.
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Affiliation(s)
- Edelle C Field-Fote
- Crawford Research Institute, Shepherd Center, Atlanta, GA; Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; Program in Applied Physiology, Georgia Institute of Technology, Atlanta, GA.
| | | | - Natalie E Tripp
- School of Public Health, Georgia State University, Atlanta, GA
| | | | | | - Steven Kirshblum
- Kessler Foundation, West Orange, NJ; Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, NJ
| | - Allen W Heinemann
- Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | - Lynn Worobey
- Departments of Physical Medicine and Rehabilitation, Bioengineering and Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | | | - Ralph J Marino
- Department of Rehabilitation Medicine, Thomas Jefferson University, Philadephia, PA
| | - Matthew J Hayat
- School of Public Health, Georgia State University, Atlanta, GA
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Tan YL, Koh MM. Prevalence of Spasticity in Nursing Home Residents: Knowing Spasticity Better and Filling in the Gaps. J Am Med Dir Assoc 2020; 21:1361-1362. [DOI: 10.1016/j.jamda.2020.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/10/2020] [Indexed: 10/24/2022]
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Tibbett JA, Field‐Fote EC, Thomas CK, Widerström‐Noga EG. Spasticity and Pain after Spinal Cord Injury: Impact on Daily Life and the Influence of Psychological Factors. PM R 2019; 12:119-129. [DOI: 10.1002/pmrj.12218] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 06/30/2019] [Indexed: 01/31/2023]
Affiliation(s)
- Jacqueline A. Tibbett
- The Miami Project to Cure Paralysis University of Miami Miami FL
- Department of Physiology and BiophysicsUniversity of Miami Miami FL
| | - Edelle C. Field‐Fote
- Shepherd Center, Crawford Research Institute Atlanta GA
- Division of Physical TherapyEmory University School of Medicine Atlanta GA
| | - Christine K. Thomas
- The Miami Project to Cure Paralysis University of Miami Miami FL
- Department of Physiology and BiophysicsUniversity of Miami Miami FL
- Department of Neurological SurgeryUniversity of Miami Miami FL
| | - Eva G. Widerström‐Noga
- The Miami Project to Cure Paralysis University of Miami Miami FL
- Department of Neurological SurgeryUniversity of Miami Miami FL
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Tibbett J, Widerström-Noga EG, Thomas CK, Field-Fote EC. Impact of spasticity on transfers and activities of daily living in individuals with spinal cord injury. J Spinal Cord Med 2019; 42:318-327. [PMID: 29334339 PMCID: PMC6522977 DOI: 10.1080/10790268.2017.1400727] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
CONTEXT/OBJECTIVE For persons with spinal cord injury, spasticity commonly interferes with activities of daily living such as transfers. Electromyography can be used to objectively measure muscle spasms during transfers, but how electromyographic measures relate to the impact spasticity has on life, or to clinically-rated spasticity, is unclear. We aimed to characterize relationships among spasm duration and magnitude, impact of spasticity on daily life, and a clinical measure of extensor spasticity, as well as to determine reliability of the electromyographic measures. DESIGN Participants (N=19) underwent electromyographic measurements of involuntary muscle activity (spasm duration and magnitude) evoked in quadriceps muscles during transfers on two days. Impact of spasticity on daily life was measured with the Spinal Cord Injury Spasticity Evaluation Tool. Clinically-rated spasticity severity was measured with the Spinal Cord Assessment Tool for Spastic reflexes. RESULTS No significant associations were found between impact of spasticity and spasm duration, spasm magnitude, or clinical extensor spasticity score. Absolute and normalized spasm duration were positively associated with clinical extensor spasticity score (rho=0.510-0.667, P < 0.05). Spasm measures during transfers had good to excellent day-to-day reliability (rho=0.656-0.846, P < 0.05). CONCLUSIONS Electromyographic and clinical measures of involuntary activity in the lower extremity do not significantly relate to perceived impact of spasticity on daily life. However, quadriceps spasm duration during transfers is related to clinically-rated extensor spasticity. Electromyography is a reliable method of quantifying quadriceps spasms during transfers. Future investigations should identify factors that influence the impact of spasticity on life, which may help direct treatment strategies to reduce problematic impact.
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Affiliation(s)
- Jacqueline Tibbett
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida,Department of Physiology and Biophysics, University of Miami, Miami, Florida,Correspondence to: Jacqueline Tibbett, University of Miami Miller School of Medicine, Miami, FL33133, USA; Ph: 305-243-8847.
| | - Eva G. Widerström-Noga
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida,Department of Neurological Surgery, University of Miami, Miami, Florida
| | - Christine K. Thomas
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida,Department of Neurological Surgery, University of Miami, Miami, Florida
| | - Edelle C. Field-Fote
- Shepherd Center, Crawford Research Institute, Atlanta, Georgia,Division of Physical Therapy, Emory University School of Medicine, Atlanta, Georgia
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Lin J, Chay W. Special Considerations in Assessing and Treating Spasticity in Spinal Cord Injury. Phys Med Rehabil Clin N Am 2019; 29:445-453. [PMID: 30626507 DOI: 10.1016/j.pmr.2018.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The assessment and treatment of spasticity can be challenging in and of itself. The aim of the authors of this article is to highlight some special considerations that may assist in the assessment and treatment approach of spasticity in individuals with spinal cord injury.
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Affiliation(s)
- John Lin
- Department of Physical Medicine and Rehabilitation, Shepherd Center, 2020 Peachtree Street Northwest, Atlanta, GA 30309, USA; Department of Rehabilitation Medicine, Emory University School of Medicine, 2020 Peachtree Road Northwest, Atlanta, GA 30309, USA
| | - Wesley Chay
- Department of Physical Medicine and Rehabilitation, Shepherd Center, 2020 Peachtree Street Northwest, Atlanta, GA 30309, USA; Department of Rehabilitation Medicine, Emory University School of Medicine, 2020 Peachtree Road Northwest, Atlanta, GA 30309, USA.
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9
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Vural M, Yalcinkaya EY, Celik EC, Gunduz B, Bozan A, Erhan B. Assessment of quality of life in relation to spasticity severity and socio-demographic and clinical factors among patients with spinal cord injury. J Spinal Cord Med 2018; 43:193-200. [PMID: 30508404 PMCID: PMC7054937 DOI: 10.1080/10790268.2018.1543093] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objective: To assess the impact of spasticity severity as well as socio-demographic and clinical factors on quality of life (QOL) and to identify factors predicting poor QOL among patients with spinal cord injury (SCI)Design: Descriptive cross-sectional study.Setting: Tertiary care clinic in Istanbul, Turkey.Participants: A total of 110 patients with SCI (mean (SD) age: 43.8 (14.7) years, 58.2% were males) were enrolled.Assessments: The American Spinal Injury Association (ASIA) Impairment Scale (AIS), Modified Ashworth Scale (MAS) and Turkish version of the World Health Organization Quality of life questionnaire (WHOQOL-BREF) were utilized to determine the SCI category, severity of spasticity and QOL scores, respectively.Outcome measures: The WHOQOL-BREF scores were evaluated with respect to the severity of spasticity, aetiology and duration of SCI, AIS category and method of bladder management.Results: The mean (SD) physical health (41.9 (15.3) vs. 46.5 (10.9), P = 0.029), social relationships (45.6 (20.2) vs. 53.8 (17.3), P = 0.025) and total WHOQOL-BREF scores were significantly lower in patients with more severe spasticity. Multivariate linear regression analysis revealed that severity of spasticity was a significant predictor of decreased WHOQOL-BREF total scores, physical domain scores and social relations domain scores by 11.381 (P = 0.007), 11.518 (P = 0.005) and 17. 965 (P = 0.004), respectively.Conclusion: In conclusion, addressing QOL in relation to severity of spasticity for the first time among Turkish SCI patients, our findings revealed a negative impact of the spasticity severity on the WHOQOL-BREF scores, particularly for physical health and social relationship domains.
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Affiliation(s)
- Meltem Vural
- University of Health Sciences, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey,Correspondence to: Meltem Vural, University of Health Sciences, Bakirkoy Dr Sadi Konuk Training Hospital, Zuhuratbaba Mh. Tevfik Saglam Cd. No:11 Bakirkoy, Istanbul, Turkey.
| | - Ebru Yilmaz Yalcinkaya
- University of Health Sciences, Istanbul Gaziosmanpasa Taksim Training and Research Hospital, Istanbul, Turkey
| | - Evrim Coskun Celik
- University of Health Sciences, Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Berrin Gunduz
- University of Health Sciences, Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Bozan
- Mardin Kiziltepe State Hospital, Mardin, Turkey
| | - Belgin Erhan
- University of Health Sciences, Istanbul Gaziosmanpasa Taksim Training and Research Hospital, Istanbul, Turkey
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Milinis K, Tennant A, Mills RJ, Al-Chalabi A, Burke G, Dick DJ, Ealing J, Hanemann CO, Harrower T, McDermott CJ, Majeed T, Pinto A, Talbot K, Williams T, Young CA. Development and validation of Spasticity Index-Amyotrophic Lateral Sclerosis. Acta Neurol Scand 2018; 138:47-54. [PMID: 29468643 DOI: 10.1111/ane.12910] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Spasticity is a common and disabling feature of amyotrophic lateral sclerosis (ALS). There are currently no validated ALS-specific measures of spasticity. The aim of this study was to develop and use a self-report outcome measure for spasticity in ALS. METHODS Following semi-structured interviews with 11 ALS patients, a draft scale was administered across ALS clinics in the UK. Internal validity of the scale was examined using the Rasch model. The numerical rating scale (NRS) for spasticity and Leeds Spasticity scale (LSS) were co-administered. The final scale was used in a path model of spasticity and quality of life. RESULTS A total of 465 patients (mean age 64.7 years (SD 10), 59% male) with ALS participated. Spasticity was reported by 80% of subjects. A pool of 71 items representing main themes of physical symptoms, negative impact and modifying factors was subject to an iterative process of item reduction by Rasch analysis resulting in a 20-item scale-the Spasticity Index for ALS (SI-ALS)-which was unidimensional and free from differential item functioning. Moderate correlations were found with LSS and NRS-spasticity. Incorporating the latent estimate of spasticity into a path model, greater spasticity reduced quality of life and motor function; higher motor function was associated with better quality of life. CONCLUSIONS The SI-ALS is a disease-specific self-report scale, which provides a robust interval-level measure of spasticity in ALS. Spasticity has a substantial impact on quality of life in ALS.
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Affiliation(s)
| | - A. Tennant
- Swiss Paraplegic Research; Nottwil Switzerland
| | - R. J. Mills
- The Walton Centre NHS Foundation Trust; Liverpool UK
- University of Liverpool; Liverpool UK
| | - A. Al-Chalabi
- Maurice Wohl Clinical Neuroscience Institute; London UK
- King's College London; London UK
| | - G. Burke
- Wessex Neurological Centre; Southampton UK
| | - D. J. Dick
- Norfolk & Norwich University Hospital; Norwich UK
| | - J. Ealing
- Salford Royal Foundation Trust; Manchester UK
- University of Manchester; Manchester UK
| | - C. O. Hanemann
- Plymouth University Peninsula Schools of Medicine and Dentistry; Plymouth UK
| | - T. Harrower
- University of Exeter; Exeter UK
- Royal Devon and Exeter Foundation Trust Hospital; Exeter UK
| | - C. J. McDermott
- Sheffield Institute for Translational Neuroscience; University of Sheffield; Sheffield UK
| | - T. Majeed
- Lancashire Teaching Hospitals; Preston UK
| | - A. Pinto
- Wessex Neurological Centre; Southampton UK
| | | | - T. Williams
- Royal Victoria Infirmary; Newcastle upon Tyne UK
| | - C. A. Young
- The Walton Centre NHS Foundation Trust; Liverpool UK
- University of Liverpool; Liverpool UK
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Shiao R, Lee-Kubli CA. Neuropathic Pain After Spinal Cord Injury: Challenges and Research Perspectives. Neurotherapeutics 2018; 15:635-653. [PMID: 29736857 PMCID: PMC6095789 DOI: 10.1007/s13311-018-0633-4] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Neuropathic pain is a debilitating consequence of spinal cord injury (SCI) that remains difficult to treat because underlying mechanisms are not yet fully understood. In part, this is due to limitations of evaluating neuropathic pain in animal models in general, and SCI rodents in particular. Though pain in patients is primarily spontaneous, with relatively few patients experiencing evoked pains, animal models of SCI pain have primarily relied upon evoked withdrawals. Greater use of operant tasks for evaluation of the affective dimension of pain in rodents is needed, but these tests have their own limitations such that additional studies of the relationship between evoked withdrawals and operant outcomes are recommended. In preclinical SCI models, enhanced reflex withdrawal or pain responses can arise from pathological changes that occur at any point along the sensory neuraxis. Use of quantitative sensory testing for identification of optimal treatment approach may yield improved identification of treatment options and clinical trial design. Additionally, a better understanding of the differences between mechanisms contributing to at- versus below-level neuropathic pain and neuropathic pain versus spasticity may shed insights into novel treatment options. Finally, the role of patient characteristics such as age and sex in pathogenesis of neuropathic SCI pain remains to be addressed.
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Affiliation(s)
- Rani Shiao
- Molecular Neurobiology Laboratory, The Salk Institute for Biological Studies, 10010 N. Torrey Pines, La Jolla, California, 92073, USA
| | - Corinne A Lee-Kubli
- Molecular Neurobiology Laboratory, The Salk Institute for Biological Studies, 10010 N. Torrey Pines, La Jolla, California, 92073, USA.
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12
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Treatment patterns of in-patient spasticity medication use after traumatic spinal cord injury: a prospective cohort study. Spinal Cord 2018; 56:1176-1183. [PMID: 29904191 DOI: 10.1038/s41393-018-0165-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/16/2018] [Accepted: 05/21/2018] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Prospective cohort study using the Rick Hansen SCI Registry (RHSCIR) and retrospective medical chart review. OBJECTIVE To describe treatment patterns of in-patient anti-spasticity medication use following traumatic spinal cord injury (SCI) in acute and rehabilitation hospital settings in British Columbia, Canada. SETTING Quaternary trauma center, rehabilitation center. METHODS Individuals with traumatic SCI between 2005 and 2014 enrolled in the Vancouver RHSCIR site (N = 917) were eligible for inclusion. Oral and injectable anti-spasticity medication use were the main outcome measures. RESULTS In 769 participants, higher neurological level and injury severity were associated with in-patient anti-spasticity medication use (p < 0.001 for both). Of individuals with cervical and thoracic injuries (n = 589), 37% were prescribed anti-spasticity medication during hospital admission. Baclofen was the most commonly used first line oral therapy. Mean (SD) and median time from injury to Baclofen initiation was 70 (69) and 50 days, respectively. The probability of having initiated an in-patient anti-spasticity medication was 55% (95% CI (49, 60)) for individuals 6 months post-injury, and 71% (95% CI (62, 79)) for individuals 12 months post-injury. At community discharge, the prevalence of oral and injectable anti-spasticity medication use was 26 and 5%. Practice patterns of anti-spasticity medication use (2005-2009 vs. 2010-2014) have not changed significantly over time. CONCLUSIONS This is the first large prospective cohort study of in-patient anti-spasticity medication use following traumatic SCI. Results from our study inform clinicians and individuals of "real world" anti-spasticity medication use among individuals with traumatic SCI and may help guide care for this population in the community.
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13
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McKay WB, Sweatman WM, Field-Fote EC. The experience of spasticity after spinal cord injury: perceived characteristics and impact on daily life. Spinal Cord 2018; 56:478-486. [DOI: 10.1038/s41393-017-0038-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 11/09/2017] [Accepted: 11/11/2017] [Indexed: 11/09/2022]
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van Dijsseldonk RB, Rijken H, van Nes IJW, van de Meent H, Keijsers NLW. A Framework for Measuring the Progress in Exoskeleton Skills in People with Complete Spinal Cord Injury. Front Neurosci 2017; 11:699. [PMID: 29311780 PMCID: PMC5732998 DOI: 10.3389/fnins.2017.00699] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/28/2017] [Indexed: 12/19/2022] Open
Abstract
For safe application of exoskeletons in people with spinal cord injury at home or in the community, it is required to have completed an exoskeleton training in which users learn to perform basic and advanced skills. So far, a framework to test exoskeleton skills is lacking. The aim of this study was to develop and test the hierarchy and reliability of a framework for measuring the progress in the ability to perform basic and advanced skills. Twelve participants with paraplegia were given twenty-four training sessions in 8 weeks with the Rewalk-exoskeleton. During the 2nd, 4th, and 6th training week the Intermediate-skills-test was performed consisting of 27 skills, measured in an hierarchical order of difficulty, until two skills were not achieved. When participants could walk independently, the Final-skills-test, consisting of 20 skills, was performed in the last training session. Each skill was performed at least two times with a maximum of three attempts. As a reliability measure the consistency was used, which was the number of skills performed the same in the first two attempts relative to the total number. Ten participants completed the training program. Their number of achieved intermediate skills was significantly different between the measurements XF2(2) = 12.36, p = 0.001. Post-hoc analysis revealed a significant increase in the median achieved intermediate skills from 4 [1–7] at the first to 10.5 [5–26] at the third Intermediate-skills-test. The rate of participants who achieved the intermediate skills decreased and the coefficient of reproducibility was 0.98. Eight participants met the criteria to perform the Final-skills-test. Their median number of successfully performed final skills was 16.5 [13–20] and 17 [14–19] skills in the first and second time. The overall consistency of >70% was achieved in the Intermediate-skills-test (73%) and the Final-skills-test (81%). Eight out of twelve participants experienced skin damage during the training, in four participants this resulted in missed training sessions. The framework proposed in this study measured the progress in performing basic and advanced exoskeleton skills during a training program. The hierarchical ordered skills-test could discriminate across participants' skill-level and the overall consistency was considered acceptable.
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Affiliation(s)
| | - Hennie Rijken
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, Netherlands
| | - Ilse J W van Nes
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, Netherlands
| | | | - Noel L W Keijsers
- Department of Research, Sint Maartenskliniek Research, Nijmegen, Netherlands.,Department of Rehabilitation, Radboudumc, Nijmegen, Netherlands
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Akpinar P, Atici A, Ozkan FU, Aktas I, Kulcu DG, Sarı A, Durmus B. Reliability of the Modified Ashworth Scale and Modified Tardieu Scale in patients with spinal cord injuries. Spinal Cord 2017; 55:944-949. [PMID: 28485384 DOI: 10.1038/sc.2017.48] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 03/27/2017] [Accepted: 03/29/2017] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Psychometrics study. OBJECTIVES To assess the reliability of the Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS) in patients with spinal cord injuries (SCIs). SETTING Inpatient rehabilitation clinics at two state hospitals. METHODS The study included 65 participants aged between 18 and 88 years with SCI with spasticity. All participants were at least 6 months after injury and had an American Spinal Injury Association Impairment Scale grade of A-D. The MAS and MTS scores were collected from the right hip adductor and hip extensor muscles, right knee extensor and knee flexor muscles and right plantar flexor muscles. Each participant was assessed twice by two experienced physiatrists 1 week apart. The raters were blinded to each other's scores. RESULTS Inter-rater and test-retest agreement for the MAS scores (κ=0.531-0.774) was moderate to substantial. Inter-rater and test-retest agreement for the MTS X scores (κ=0.692-0.917) was substantial to almost perfect. Inter-rater reliability and test-retest reliability of the MTS R2-R1 was excellent (intra-class correlation coefficient (ICC) 0.874-0.973, confidence interval (CI): 0.79-0.98) for all muscles tested. Inter-rater reliability of the MTS R2 for the hip adductor and knee extensor muscles was poor (ICC 0.248, CI: -0.00 to 0.47 and ICC 0.094, CI: -0.16 to 0.34, respectively). The test-retest reliability of the MTS R2 was also poor for the knee extensor muscles (ICC 0.318, CI: -0.06 to 0.53). CONCLUSION MAS has adequate reliability for determining lower-extremity spasticity in patients with SCI. The demonstration of excellent inter-rater reliability and test-retest reliability of the MTS R2-R1 suggests its utility as a complementary tool for informing treatment decisions in patients with SCI.
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Affiliation(s)
- P Akpinar
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - A Atici
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - F U Ozkan
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - I Aktas
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - D G Kulcu
- Department of Physical Medicine and Rehabilitation, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
| | - A Sarı
- Department of Physical Medicine and Rehabilitation, Erenkoy Physical Medicine and Rehabilitation Hospital, Istanbul, Turkey
| | - B Durmus
- Department of Physical Medicine and Rehabilitation, Erenkoy Physical Medicine and Rehabilitation Hospital, Istanbul, Turkey
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Akpinar P, Atici A, Ozkan FU, Aktas I, Kulcu DG, Kurt KN. Reliability of the Spinal Cord Assessment Tool for Spastic Reflexes. Arch Phys Med Rehabil 2016; 98:1113-1118. [PMID: 27744026 DOI: 10.1016/j.apmr.2016.09.119] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/01/2016] [Accepted: 09/13/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess the reliability of the Spinal Cord Assessment Tool for Spastic Reflexes (SCATS). DESIGN Observational reliability study of the SCATS. SETTING Inpatient rehabilitation unit at an education and research hospital. PARTICIPANTS Subjects (N=47) between the ages of 18 and 88 years with spinal cord injury (SCI) and with American Spinal Injury Association Impairment Scale grades from A to D with spasticity, who were at least 6 months postinjury. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Interrater and test-retest reliability of the SCATS. RESULTS The SCATS had substantial to almost perfect interrater agreement (κ=.669-1.000) between the 2 physiatrists. Test-retest agreement of the SCATS was also substantial to almost perfect (κ=.614-1.000) as well. There was a significant correlation between the SCATS clonus scores and the Modified Ashworth scores of the hip, knee, and ankle. No correlation was found between SCATS extensor spasm scores and Modified Ashworth scores. The SCATS flexor spasm scores were only correlated significantly with the ankle plantar flexor Modified Ashworth scores (P<.05). CONCLUSIONS The SCATS is a reliable tool for assessing spasm activity and spastic hypertonia in patients with SCI.
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Affiliation(s)
- Pinar Akpinar
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey.
| | - Arzu Atici
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - Feyza U Ozkan
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - Ilknur Aktas
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - Duygu G Kulcu
- Department of Physical Medicine and Rehabilitation, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Kubra Neslihan Kurt
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
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Eftekhar P. Clinician's Commentary on Cheung et al.(1). Physiother Can 2015; 67:167-8. [PMID: 25931668 DOI: 10.3138/ptc.2014-07-cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Parvin Eftekhar
- University of Toronto; Stroke-Spasticity Clinic, UHN-Toronto Rehab
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Cheung J, Rancourt A, Di Poce S, Levine A, Hoang J, Ismail F, Boulias C, Phadke CP. Patient-identified factors that influence spasticity in people with stroke and multiple sclerosis receiving botulinum toxin injection treatments. Physiother Can 2015; 67:157-66. [PMID: 25931667 DOI: 10.3138/ptc.2014-07] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe the nature, extent, and impact of spasticity; determine factors that are perceived to influence its severity; and examine the relationship between time since diagnosis and impact of spasticity on daily activities in people with stroke and multiple sclerosis (MS) who are receiving botulinum toxin injection treatments. METHODS After a cross-sectional telephone survey, descriptive statistics and correlations were analyzed separately for the stroke and MS groups. RESULTS A total of 29 people with stroke and 10 with MS were surveyed. Both groups perceived increased spasticity with outdoor cold (69% stroke, 60% MS), muscle fatigue (59% stroke, 80% MS), and mental stress (59% stroke, 90% MS). No statistically significant correlations were found between time since diagnosis and perceived impact of spasticity on function in the stroke (r=0.07, p=0.37) or MS (r=0.16, p=0.33) groups. The MS group experienced bilateral and more severe perception of spasticity in the legs than the stroke group and identified more factors as worsening their spasticity (p<0.05). Severity of leg (but not arm) spasticity was significantly correlated with severity of impact of the following factors in the MS group only: lying on the back (r=0.70, p<0.05), outdoor heat (r=0.61, p<0.05), and morning (r=0.59, p<0.05). CONCLUSION Intrinsic and extrinsic triggers can influence the perception of spasticity differently depending on individual factors, severity, location (arm vs. leg), and distribution of spasticity (unilateral vs. bilateral). Clinicians can use the findings to better understand, educate, and treat people with stroke and MS.
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Affiliation(s)
| | | | | | | | | | - Farooq Ismail
- Spasticity Research Program, West Park Healthcare Centre ; Division of Physiatry, University of Toronto
| | - Chris Boulias
- Spasticity Research Program, West Park Healthcare Centre ; Division of Physiatry, University of Toronto
| | - Chetan P Phadke
- Department of Physical Therapy ; Spasticity Research Program, West Park Healthcare Centre ; Faculty of Health, York University, Toronto
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Functional hindrance due to spasticity in individuals with spinal cord injury during inpatient rehabilitation and 1 year thereafter. Spinal Cord 2015; 53:663-7. [PMID: 25777334 DOI: 10.1038/sc.2015.41] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 12/31/2013] [Accepted: 01/06/2015] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVE To assess functional hindrance due to spasticity during inpatient rehabilitation and 1 year thereafter in individuals with spinal cord injury (SCI) and to determine factors that influence the hindrance. SETTING Eight specialized rehabilitation centres in the Netherlands. METHODS A total of 203 patients with recent SCI rated the hindrance they perceived due to spasticity in daily living at the start of active rehabilitation (t1), 3 months later (t2), at discharge (t3) and 1 year after discharge (t4). Hindrance was dichotomized into absent or negligible and present. Multilevel regression analyses were performed to determine the course of functional hindrance due to spasticity and its associations with possible determinants-namely, age, gender, cause, lesion level, motor completeness, spasticity and anti-spasticity medication. RESULTS The percentage of individuals that indicated functional hindrance due to spasticity ranged from 54 to 62% over time and did not change significantly over time (Δt3t1 odds ratio (OR)=0.85, P=0.44; Δt3t2 OR=1.20, P=0.41; Δt3t4 OR=0.91, P=0.67). The percentage of individuals who experienced a lot of hindrance due to spasticity during specific activities ranged from 4 to 27%. The odds for experiencing functional hindrance due to spasticity were significantly higher for individuals with tetraplegia (OR=2.17, P=0.0001), more severe spasticity (OR=5.51, P<0.0001) and for those using anti-spasticity medication (OR=4.18, P<0.0001). CONCLUSION Functional hindrance due to spasticity occurred in the majority of persons with SCI and did not change significantly during inpatient rehabilitation and 1 year thereafter. Factors that influence hindrance were determined.
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Balioussis C, Hitzig SL, Flett H, Noreau L, Craven BC. Identifying and classifying quality of life tools for assessing spasticity after spinal cord injury. Top Spinal Cord Inj Rehabil 2014; 20:208-24. [PMID: 25484567 DOI: 10.1310/sci2003-208] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To identify and classify tools for assessing the influence of spasticity on quality of life (QOL) after spinal cord injury (SCI). METHODS Electronic databases (MEDLINE/PubMed CINAHL and PsycInfo) were searched for studies published between 1975 and 2012. Dijkers's theoretical framework on QOL was used to classify tools as either objective or subjective measures of QOL. RESULTS Sixteen studies met the inclusion criteria. Identified objective measures that were used to assess the influence of spasticity on QOL included the Short Form-36 (SF-36) the Sickness Impact Profile (SIP) and the Health Utilities Index-III (HUI-III). Subjective measures included the Quality of Life Index-SCI Version III (QLI-SCI) Life Situation Questionnaire-Revised (LSQ-R) Reciprocal Support Scale (RSS) Profile of Mood States (POMS) Spinal Cord Injury Spasticity Evaluation Tool (SCI-SET) and the Patient Reported Impact of Spasticity Measure (PRISM). A number of tools proved either to be insensitive to the presence of spasticity (QLI-SCI) or yielded mixed (SF-36) or weak (RSS LSQ-R) results. Tools that were sensitive to spasticity had limited psychometric data for use in the SCI population (HUI-III SIP POMS) although 2 were developed specifically for assessing spasticity on daily life post SCI (SCI-SET PRISM). CONCLUSIONS Two condition-specific subjective measures the SCI-SET and PRISM emerged as the most promising tools for the assessment of spasticity impact on QOL after SCI. Further research should focus on establishing the psychometric properties of these measures for use in the SCI population.Key words: outcome measurement quality of life spasticity spinal cord injury.
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Affiliation(s)
- Christina Balioussis
- Lyndhurst Centre, Toronto Rehabilitation Institute - University Health Network , Toronto, Ontario , Canada
| | - Sander L Hitzig
- Institute for Life Course and Aging, Faculty of Medicine, University of Toronto , Toronto, Ontario , Canada
| | - Heather Flett
- Lyndhurst Centre, Toronto Rehabilitation Institute - University Health Network , Toronto, Ontario , Canada
| | - Luc Noreau
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS) , Québec, Québec , Canada ; Départment de réadaptation,Faculté de Médecine, Université Laval , Québec, Québec , Canada
| | - B Catharine Craven
- Lyndhurst Centre, Toronto Rehabilitation Institute - University Health Network , Toronto, Ontario , Canada ; Department of Medicine, Division of Physiatry, University of Toronto , Toronto, Ontario , Canada
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Behrens J, Pfüller C, Mansow-Model S, Otte K, Paul F, Brandt AU. Using perceptive computing in multiple sclerosis - the Short Maximum Speed Walk test. J Neuroeng Rehabil 2014; 11:89. [PMID: 24886525 PMCID: PMC4041903 DOI: 10.1186/1743-0003-11-89] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 05/22/2014] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND We investigated the applicability and feasibility of perceptive computing assisted gait analysis in multiple sclerosis (MS) patients using Microsoft Kinect™. To detect the maximum walking speed and the degree of spatial sway, we established a computerized and observer-independent measure, which we named Short Maximum Speed Walk (SMSW), and compared it to established clinical measures of gait disability in MS, namely the Expanded Disability Status Scale (EDSS) and the Timed 25-Foot Walk (T25FW). METHODS Cross-sectional study of 22 MS patients (age mean ± SD 43 ± 9 years, 13 female) and 22 age and gender matched healthy control subjects (HC) (age 37 ± 11 years, 13 female). The disability level of each MS patient was graded using the EDSS (median 3.0, range 0.0-6.0). All subjects then performed the SMSW and the Timed 25-Foot Walk (T25FW). The SMSW comprised five gait parameters, which together assessed average walking speed and gait stability in different dimensions (left/right, up/down and 3D deviation). RESULTS SMSW average walking speed was slower in MS patients (1.6 ± 0.3 m/sec) than in HC (1.8 ± 0.4 m/sec) (p = 0.005) and correlated well with EDSS (Spearman's Rho 0.676, p < 0.001). Furthermore, SMSW revealed higher left/right deviation in MS patients compared to HC. SMSW showed high recognition quality and retest-reliability (covariance 0.13 m/sec, ICC 0.965, p < 0.001). There was a significant correlation between SMSW average walking speed and T25FW (Pearson's R = -0.447, p = 0.042). CONCLUSION Our data suggest that ambulation tests using Microsoft Kinect™ are feasible, well tolerated and can detect clinical gait disturbances in patients with MS. The retest-reliability was on par with the T25FW.
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Affiliation(s)
| | | | | | | | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
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Vierck CJ, Cannon RL, Acosta-Rua AJ. Evaluation of lateral spinal hemisection as a preclinical model of spinal cord injury pain. Exp Brain Res 2013; 228:305-12. [PMID: 23681298 DOI: 10.1007/s00221-013-3563-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 05/04/2013] [Indexed: 12/22/2022]
Abstract
Operant escape from nociceptive thermal stimulation of 13 Long-Evans rats was compared before and after lateral spinal hemisection, to determine whether this lesion configuration provides an appropriate preclinical model of the hyperalgesia that can be associated with human spinal cord injury. Escape from 44 °C and from 47 °C stimulation was not affected following sham spinal surgery but was significantly reduced over 20 weeks of postoperative testing following lateral spinal hemisection. This result is opposite to previous reports of enhanced reflex withdrawal in response to thermal stimulation of rats following lateral spinal hemisection. In addition, the latency of reflexive lick/guard responses to 44 °C was increased and the duration of lick/guard responding was decreased in the present study (hyporeflexia). Thus, previous assessments of simple withdrawal reflexes have described a hyperreflexia following lateral spinal hemisection that was not replicated by lick/guard testing, and postoperative escape responding revealed hypoalgesia rather than the increased pain sensitivity expected in a model of chronic pain.
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Affiliation(s)
- Charles J Vierck
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL 32610-0244, USA.
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Adriaansen JJE, van Asbeck FWA, Lindeman E, van der Woude LHV, de Groot S, Post MWM. Secondary health conditions in persons with a spinal cord injury for at least 10 years: design of a comprehensive long-term cross-sectional study. Disabil Rehabil 2012; 35:1104-10. [DOI: 10.3109/09638288.2012.712196] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Balantrapu S, Sandroff BM, Sosnoff JJ, Motl RW. Perceived impact of spasticity is associated with spatial and temporal parameters of gait in multiple sclerosis. ISRN NEUROLOGY 2012; 2012:675431. [PMID: 22462022 PMCID: PMC3302106 DOI: 10.5402/2012/675431] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Accepted: 10/02/2011] [Indexed: 11/28/2022]
Abstract
Background. Spasticity is prevalent and disabling in persons with multiple sclerosis (MS), and the development of the Multiple Sclerosis Spasticity Scale-88 (MSSS-88) provides an opportunity for examining the perceived impact of spasticity and its association with gait in this population. Purpose. This study examined the association between the perceived impact of spasticity and spatio-temporal parameters of gait in persons with MS. Methods. The sample included 44 adults with MS who completed the MSSS-88 and 4 walking trials on a 26-foot GAITRiteTM electronic walkway for measurement of spatio-temporal components of gait including velocity, cadence, base of support, step time, single support, double support, and swing phase. Results. The overall MSSS-88 score was significantly associated with velocity (r = −0.371), cadence (r = −0.306), base of support (r = 0.357), step time (r = 0.305), single leg support (r = −0.388), double leg support (r = 0.379), and swing phase (r = −0.386). Conclusions. The perceived impact of spasticity coincides with alterations of the spatio-temporal parameters of gait in MS. This indicates that subsequent interventions might target a decrease in spasticity or its perceived impact as an approach for improving mobility in MS.
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Affiliation(s)
- Swathi Balantrapu
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
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Westerkam D, Saunders LL, Krause JS. Association of spasticity and life satisfaction after spinal cord injury. Spinal Cord 2011; 49:990-4. [PMID: 21606929 PMCID: PMC3166438 DOI: 10.1038/sc.2011.49] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective To identify the relationship between spasticity and life satisfaction as measured by 3 multi-item factor scales and a rating of overall quality of life among participants with spinal cord injury (SCI). Study Design Cross-sectional survey; secondary analysis of existing data by linear regression analysis between spasticity and quality of life. Setting Large specialty hospital in the Southeastern United States. Methods Participants included 1,549 adults with traumatic spinal cord injuries, at least 18 years of age and a minimum of 1 year post-injury at survey. Outcome measures included: (1) Home Life Satisfaction, (2) Global Satisfaction, (3) Vocational Satisfaction, (4) Overall Quality of Life and (5) three subscales from the Patient Reported Impact of Spasticity Measure. Results Three aspects of spasticity (Daily Activities, Positive Impact, and spasticity at its worst) all were negatively correlated with Home Life Satisfaction, Global Satisfaction, and Overall Quality of Life. Only the Daily Activities scale and the spasticity at its worst rating had a significant negative correlation with Vocational Satisfaction. Conclusion Spasticity is negatively associated with quality of life after SCI. These negative outcomes need to be considered in an individual’s rehabilitation and treatment methods.
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Baastrup C, Maersk-Moller CC, Nyengaard JR, Jensen TS, Finnerup NB. Spinal-, brainstem- and cerebrally mediated responses at- and below-level of a spinal cord contusion in rats: evaluation of pain-like behavior. Pain 2010; 151:670-679. [PMID: 20863621 DOI: 10.1016/j.pain.2010.08.024] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 08/13/2010] [Accepted: 08/18/2010] [Indexed: 11/16/2022]
Abstract
Pain is a frequent consequence of spinal cord injury (SCI) which may profoundly impair the patients' quality of life. Valid experimental models and methods are therefore desirable in the search for better treatments. Usually, experimental pain assays depend on stimulus-evoked withdrawal responses; however, this spinal-mediated reflex response may be particularly problematic when evaluating below-level SCI pain due to the development of hyperactive reflex circuitries. In this study, we applied and compared assays measuring cold (acetone), static (von Frey filaments), and dynamic mechanical (soft brush) hypersensitivity at different levels of the neuroaxis at and below the level of injury in a rat model of SCI. We induced an experimental SCI (MASCIS 25 mm weight-drop) and evaluated the development of spinal reflexes (withdrawal), spinal-brainstem-spinal reflexes (licking, guarding, struggling, vocalizing, jumping, and biting) and cerebral-dependent behavior (place escape/avoidance paradigm (PEAP)). We demonstrated increased brainstem reflexes and cerebrally mediated aversive reactions to stimuli applied at the level of SCI, suggesting development of at-level evoked pain behavior. Furthermore, stimulation below-level increased innate reflex responses without increasing brainstem reflexes or aversive behavior in the PEAP, suggesting development of the spasticity syndrome rather than pain-like behavior. While spinal reflex measures are acceptable for studying changes in the spinal reflex pathways and spinal cord, they are not suited as nociceptive behavioral measures. Measuring brainstem organized responses eliminates the bias associated with the spastic syndrome, but pain requires cortical involvement. Methods depending on cortical structures, as the PEAP, are therefore optimal endpoints in animal models of central pain.
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Affiliation(s)
- Cathrine Baastrup
- Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark Stereology & Electron Microscopy Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
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Epidermal neural crest stem cell (EPI-NCSC)--mediated recovery of sensory function in a mouse model of spinal cord injury. Stem Cell Rev Rep 2010; 6:186-98. [PMID: 20414748 PMCID: PMC2887506 DOI: 10.1007/s12015-010-9152-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Here we show that epidermal neural crest stem cell (EPI-NCSC) transplants in the contused spinal cord caused a 24% improvement in sensory connectivity and a substantial recovery of touch perception. Furthermore we present a novel method for the ex vivo expansion of EPI-NCSC into millions of stem cells that takes advantage of the migratory ability of neural crest stem cells and is based on a new culture medium and the use of microcarriers. Functional improvement was shown by two independent methods, spinal somatosensory evoked potentials (SpSEP) and the Semmes-Weinstein touch test. Subsets of transplanted cells differentiated into myelinating oligodendrocytes. Unilateral injections of EPI-NCSC into the lesion of midline contused mouse spinal cords elicited bilateral improvements. Intraspinal EPI-NCSC did not migrate laterally in the spinal cord or invade the spinal roots and dorsal root ganglia, thus implicating diffusible factors. EPI-NCSC expressed neurotrophic factors, angiogenic factors, and metalloproteases. The strength of EPI-NCSC thus is that they can exert a combination of pertinent functions in the contused spinal cord, including cell replacement, neuroprotection, angiogenesis and modulation of scar formation. EPI-NCSC are uniquely qualified for cell-based therapy in spinal cord injury, as neural crest cells and neural tube stem cells share a higher order stem cell and are thus ontologically closely related.
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Kirchberger I, Sinnott A, Charlifue S, Kovindha A, Lüthi H, Campbell R, Zwecker M, Scheuringer M, Cieza A. Functioning and disability in spinal cord injury from the consumer perspective: an international qualitative study using focus groups and the ICF. Spinal Cord 2010; 48:603-13. [PMID: 20065983 DOI: 10.1038/sc.2009.184] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
STUDY DESIGN Qualitative, multi-center study. OBJECTIVES To examine the lived experiences of persons with spinal cord injury (SCI) in both the early post-acute and the long-term context using the International Classification of Functioning, Disability and Health (ICF) as a frame of reference. SETTING International study sites representing the six World Health Organization world regions. METHODS A qualitative study using focus groups methodology was conducted. Sample size was determined by saturation. The focus groups were digitally recorded and transcribed verbatim. The meaning condensation procedure was used for the data analysis. The resulting meaningful concepts were linked to ICF categories according to established linking rules. RESULTS Forty-nine focus groups with 230 participants were performed. Saturation was reached in four out of the six world regions. A total of 3122 and 4423 relevant concepts were identified in the focus groups for the early post-acute and the long-term context, respectively, and linked to a total of 171 and 188 second-level categories. All chapters of the ICF components Body functions, Activities and participation and Environmental factors were represented by the linked ICF categories. In all, 36 and 113 concepts, respectively, are not classified by the ICF and 306 and 444, respectively, could be assigned to the ICF component Personal Factors, which is not yet classified. CONCLUSION A broad range of the individual experiences of persons with SCI is covered by the ICF. A large number of experiences were related to Personal Factors.
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Affiliation(s)
- I Kirchberger
- ICF Research Branch of the WHO FIC CC (DIMDI), IHRS, Ludwig-Maximilian University, Munich, Germany
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