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Xing H, Liu N, Li K, Cui G, Biering-Sørensen F. Translation and validation of the Chinese self-report version of Spinal Cord Independence Measure (SCIM-SR): Rasch psychometric analysis and online application. Comput Struct Biotechnol J 2024; 24:258-263. [PMID: 38623183 PMCID: PMC11016810 DOI: 10.1016/j.csbj.2024.03.029] [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: 09/01/2023] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/17/2024] Open
Abstract
Spinal Cord Independence Measure (SCIM) was an important functional outcome measure specifically designed for spinal cord injury (SCI) patients, with the self-reported version of SCIM (SCIM-SR) published in 2013. This study aims to translate the SCIM-SR into Chinese, and to investigate the validity of Chinese SCIM-SR among SCI patients. This Chinese version of SCIM-SR was translated into Chinese in a standardized approach, and then filled out by a sample of patients with SCI (n = 205) within 3 days after admission. Validity of Chinese SCIM-SR was then analyzed using Rasch analysis and principal component analysis. The subscale Selfcare and subscale Mobility showed good fit to the Rasch model, with no significance found in Chi-square test results for item-trait interaction, using Bonferroni adjustment for the significant level (χ2 =18.125, P = 0.111; χ2 =33.629, P = 0.006). Mean fit residual for items and persons of each subscale were within ± 2.5. The model fit of the subscale of Respiration and Sphincter Management was not satisfactory even after deleting one item and merging two items with local dependence. However, Kaiser-Meyer-Olkin test was > 0.50 in total score and all the subscales of Chinese SCIM-SR, and P < 0.05 in the Bartlett's test. There was no differential item functioning for gender, time post injury, age, and etiology in any of the three subscales. An online version of Chinese SCIM-SR was also developed. It is concluded that the SCIM-SR in Chinese is valid for application in individuals with SCI. SCIM-SR is considered as an important tool for self-reporting functional status from SCI individuals' perspective.
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Affiliation(s)
- Huayi Xing
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Nan Liu
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Kun Li
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Guoqing Cui
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Fin Biering-Sørensen
- Department of Clinical Medicine, University of Copenhagen, and Department of Brain- and Spinal Cord Injuries, Copenhagen University Hospital, Bodil Eskesen Center, Rigshospitalet, Copenhagen, Denmark
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Bluvshtein V, Catz A, Benjamini Y, Refaeli D, Front L, Bizzarini E, Margalho P, Soeira TP, Kesiktas N, Aidinoff E. Assessment of ability realization using the 4th version of the Spinal Cord Independence Measure. J Spinal Cord Med 2024:1-8. [PMID: 39037152 DOI: 10.1080/10790268.2024.2374132] [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: 07/23/2024] Open
Abstract
CONTEXT Change in ability realization reflects the main contribution of rehabilitation to improvement in the performance of daily activities after spinal cord lesions (SCL). OBJECTIVE To adapt a Spinal Cord Ability Realization Measurement Index (SCI-ARMI) formula to the new Spinal Cord Independence Measure version 4 (SCIM4). METHODS Using data from 156 individuals for whom American Spinal Injury Association Motor Score (AMS) and SCIM4 scores were collected, we obtained an estimate for the highest possible SCIM4 given the patient's AMS value, using the 95th percentile of SCIM4 values at discharge from rehabilitation (SCIM95) for patients with any given AMS at discharge. We used the statistical software environment R to implement the quantile regression method for linear and quadratic formulas. We also compared the computed model with the SCIM95 model obtained using data from the present study group, positioned in the SCIM95 formula developed for SCIM3. RESULTS The coefficients of the computed SCIM95 formula based on SCIM4 scores were statistically non-significant, which hypothetically reflects the small sample relative to the goal of estimating SCIM4 95th percentile. Predicting the ability using SCIM4 scores positioned in the SCIM95 formula used for SCIM3, however, yielded SCIM95 values, which are very close to those of the new SCIM95 formula (Mean difference 2.16, 95% CI = 1.45, 4.90). CONCLUSION The SCI-ARMI formula, which is based on the SCIM95 formula developed for SCIM3, is appropriate for estimating SCI-ARMI at present, when SCIM4 scores are available. When sufficient additional data accumulates, it will be appropriate to introduce a modified SCI-ARMI formula.
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Affiliation(s)
- Vadim Bluvshtein
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amiram Catz
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Benjamini
- School of Mathematical Sciences, Tel Aviv University, Tel Aviv, Israel
| | - David Refaeli
- School of Mathematical Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Lilach Front
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
| | | | | | | | - Nur Kesiktas
- Istanbul Physical Medicine and Rehabilitation Hospital, University of Health Sciences, Istanbul, Turkey
| | - Elena Aidinoff
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Heuer A, Stuecker S, Stuecker R, Mladenov K. Pelvic Fixation for Non-Ambulatory Patients with Neuromuscular Scoliosis Treated with Magnetically Controlled Growing Rods-A 4-Year Comparison of Two Different Fixation Methods. J Clin Med 2024; 13:3845. [PMID: 38999412 PMCID: PMC11242402 DOI: 10.3390/jcm13133845] [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: 06/04/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: This study aims to analyze the efficacy and safety of the two pelvic fixation systems, S-hooks (SH) and lumbar-sacral-alar-iliac (SAI) screws, when used in association with magnetically controlled growing rods (MCGRs) in non-ambulatory children with severe neuromuscular scoliosis (NMS). Methods: Forty-one patients were retrospectively examined and subdivided corresponding to ilium hook fixation or SAI screws. The major curve correction (%) and pelvic obliquity (PO) correction (%) were assessed utilizing scoliosis plain film radiographs over time. Complications and unplanned return to the operating room (UPROR) were recorded. Patient-specific pre- and postoperative values were included in a backward stepwise regression model to assess UPROR. Results: Mean age at index intervention was 9.4 years. Preoperative main curve was 81° and PO was 22°. 21 and 20 patients were categorized into the SH and SAI subgroups, respectively. Initial curve correction was significantly better in the SAI subgroup (63 vs. 42% in the SH, p = 0.045), while PO correction was equally good. Curve and PO correction were maintained throughout the follow-up period of 55 months. UPROR rate was 38% in the SH subgroup, and 5% in the SAI subgroup (p = 0.010). Regression analysis identified postoperative curve correction as predictive value for UPROR (p = 0.006). Conclusions: SAI screw fixation has a low UPROR rate and achieves superior curve correction. S-hooks are a viable option to correct PO and NMS in children with high operative risk to reduce operative time, but revision surgery is not uncommon.
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Affiliation(s)
- Annika Heuer
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf (UKE), Martinistrasse 52, 20246 Hamburg, Germany
- Pediatric Orthopaedic Department, Altona Children’s Hospital, Bleickenallee 38, 22763 Hamburg, Germany
| | - Sebastian Stuecker
- Pediatric Orthopaedic Department, Altona Children’s Hospital, Bleickenallee 38, 22763 Hamburg, Germany
- Department of Orthopaedics, University Medical Center Hamburg-Eppendorf (UKE), Martinistrasse 52, 20246 Hamburg, Germany
| | - Ralf Stuecker
- Pediatric Orthopaedic Department, Altona Children’s Hospital, Bleickenallee 38, 22763 Hamburg, Germany
- Department of Orthopaedics, University Medical Center Hamburg-Eppendorf (UKE), Martinistrasse 52, 20246 Hamburg, Germany
| | - Kiril Mladenov
- Pediatric Orthopaedic Department, Altona Children’s Hospital, Bleickenallee 38, 22763 Hamburg, Germany
- Department of Orthopaedics, University Medical Center Hamburg-Eppendorf (UKE), Martinistrasse 52, 20246 Hamburg, Germany
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Wu X, Xi X, Xu M, Gao M, Liang Y, Sun M, Hu X, Mao L, Liu X, Zhao C, Sun X, Yuan H. Prediction of early bladder outcomes after spinal cord injury: The HALT score. CNS Neurosci Ther 2024; 30:e14628. [PMID: 38421138 PMCID: PMC10850821 DOI: 10.1111/cns.14628] [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: 11/02/2023] [Revised: 12/28/2023] [Accepted: 01/15/2024] [Indexed: 03/02/2024] Open
Abstract
AIMS Neurogenic bladder (NB) is a prevalent and debilitating consequence of spinal cord injury (SCI). Indeed, the accurate prognostication of early bladder outcomes is crucial for patient counseling, rehabilitation goal setting, and personalized intervention planning. METHODS A retrospective exploratory analysis was conducted on a cohort of consecutive SCI patients admitted to a rehabilitation facility in China from May 2016 to December 2022. Demographic, clinical, and electrophysiological data were collected within 40 days post-SCI, with bladder outcomes assessed at 3 months following SCI onset. RESULTS The present study enrolled 202 SCI patients with a mean age of 40.3 ± 12.3 years. At 3 months post-SCI, 79 participants exhibited complete bladder emptying. Least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression analyses identified the H-reflex of the soleus muscle, the American Spinal Injury Association Lower Extremity Motor Score (ASIA-LEMS), and the time from lesion to rehabilitation facility (TLRF) as significant independent predictors for bladder emptying. A scoring system named HALT was developed, yielding a strong discriminatory performance with an area under the receiver operating characteristics curve (aROC) of 0.878 (95% CI: 0.823-0.933). A simplified model utilizing only the H-reflex exhibited excellent discriminatory ability with an aROC of 0.824 (95% CI: 0.766-0.881). Both models demonstrated good calibration via the Hosmer-Lemeshow test and favorable clinical net benefits through decision curve analysis (DCA). In comparison to ASIA-LEMS, both the HALT score and H-reflex showed superior predictive accuracy for bladder outcome. Notably, in individuals with incomplete injuries, the HALT score (aROC = 0.973, 95% CI: 0.940-1.000) and the H-reflex (aROC = 0.888, 95% CI: 0.807-0.970) displayed enhanced performance. CONCLUSION Two reliable models, the HALT score and the H-reflex, were developed to predict bladder outcomes as early as 3 months after SCI onset. Importantly, this study provides hitherto undocumented evidence regarding the predictive significance of the soleus H-reflex in relation to bladder outcomes in SCI patients.
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Affiliation(s)
- Xiangbo Wu
- Department of Rehabilitation Medicine, Xijing HospitalAir Force Medical University (Fourth Military Medical University)Xi'anChina
| | - Xiao Xi
- Department of Rehabilitation Medicine, Xijing HospitalAir Force Medical University (Fourth Military Medical University)Xi'anChina
| | - Mulan Xu
- Department of Rehabilitation Medicine, Xijing HospitalAir Force Medical University (Fourth Military Medical University)Xi'anChina
- Department of Rehabilitation Medicine, Shenshan Medical Center, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityShanweiGuangdongChina
| | - Ming Gao
- Department of Rehabilitation Medicine, Xijing HospitalAir Force Medical University (Fourth Military Medical University)Xi'anChina
| | - Ying Liang
- Department of Health StatisticsAir Force Medical University (Fourth Military Medical University)Xi'anChina
| | - Miaoqiao Sun
- Department of Rehabilitation Medicine, Xijing HospitalAir Force Medical University (Fourth Military Medical University)Xi'anChina
| | - Xu Hu
- Department of Rehabilitation Medicine, Xijing HospitalAir Force Medical University (Fourth Military Medical University)Xi'anChina
| | - Li Mao
- Department of Rehabilitation Medicine, Xijing HospitalAir Force Medical University (Fourth Military Medical University)Xi'anChina
| | - Xingkai Liu
- Department of Rehabilitation Medicine, Xijing HospitalAir Force Medical University (Fourth Military Medical University)Xi'anChina
| | - Chenguang Zhao
- Department of Rehabilitation Medicine, Xijing HospitalAir Force Medical University (Fourth Military Medical University)Xi'anChina
| | - Xiaolong Sun
- Department of Rehabilitation Medicine, Xijing HospitalAir Force Medical University (Fourth Military Medical University)Xi'anChina
| | - Hua Yuan
- Department of Rehabilitation Medicine, Xijing HospitalAir Force Medical University (Fourth Military Medical University)Xi'anChina
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Li F, Wei C, Huo S, Liu X, Du J. Noninvasive Brain Stimulation for Motor Dysfunction After Incomplete Spinal Cord Injury: A Systematic Review and Meta-analysis. Am J Phys Med Rehabil 2024; 103:53-61. [PMID: 37408131 DOI: 10.1097/phm.0000000000002311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
OBJECTIVE We aimed to examine the effectiveness of noninvasive brain stimulation on motor dysfunction after incomplete spinal cord injury. METHODS The PubMed, Embase, and Cochrane Library were searched from the inception dates to April 30, 2022. Randomized controlled trials comparing the effects of noninvasive brain stimulation and sham stimulation on motor dysfunction in patients with incomplete spinal cord injury were included. Two reviewers performed the data extraction and assessed study quality using Cochrane Collaboration's Tool. The primary outcomes involved upper limb function, lower limb function, spasticity, and activities of daily living. They were analyzed using meta-analysis method and the results were reported as standardized mean difference with 95% confidence interval. RESULTS Fourteen studies involving 225 patients were included. Noninvasive brain stimulation reduced spasticity at the end of intervention (standardized mean difference = -0.68, 95% confidence interval = -1.32 to -0.03, P = 0.04) and 1-wk follow-up (standardized mean difference = -0.82, 95% confidence interval = -1.48 to -0.16, P = 0.02), but no beneficial effect at 1-mo follow-up (standardized mean difference = -0.32, 95% confidence interval = -1.06 to 0.42, P = 0.39). In addition, noninvasive brain stimulation also increased lower limb muscle strength at 1-mo follow-up (standardized mean difference = 0.69, 95% confidence interval = 0.11 to 1.28, P = 0.02). Other main outcomes were similar between groups. CONCLUSIONS Noninvasive brain stimulation can reduce spasticity, and the favorable effect can sustain for 1 wk after intervention. In addition, noninvasive brain stimulation can increase lower limb muscle strength at 1-mo follow-up.
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Affiliation(s)
- Fang Li
- From the Department of Rehabilitation Medicine, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China (FL, SH, XL, JD); and School of Mathematics and Statistics, Beijing Jiaotong University, Beijing, People's Republic of China (CW)
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Bluvshtein V, Catz A, Gelernter I, Kfir A, Front L, Michaeli D, Bizzarini E, Margalho P, Soeira TP, Kesiktas N, Aidinoff E. The net contribution of rehabilitation to improvement in performance in patients with spinal cord lesions in five countries. J Spinal Cord Med 2023:1-7. [PMID: 37861289 DOI: 10.1080/10790268.2023.2271200] [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: 10/21/2023] Open
Abstract
CONTEXT Change in ability realization reflects the main contribution of rehabilitation to improvement in the performance of daily activities in patients with spinal cord lesions (SCL). OBJECTIVE To assess the net effect of rehabilitation of patients with SCL and compare it between countries. METHODS We calculated the Spinal Cord Ability Realization Measurement Index (SCI-ARMI) and its change from admission to rehabilitation to discharge, for inpatients admitted to SCL units in five countries, between 2016 and 2019. We used chi-square tests, analysis of variance (ANOVA), McNemar's test, Pearson's correlations, and analysis of covariance (ANCOVA) to compare countries and patient groups and assess the relationships of various factors with SCI-ARMI gain during rehabilitation. RESULTS The study included 218 inpatients (67% males, age 52 ± 17). In Brazil, Israel, Italy, Portugal, and Turkiye, respectively, SCI-ARMI gain was 2 (SD = 15), 19 (SD = 17), 31 (SD = 23), 13 (SD = 15), and 16 (SD = 12). Yet, after controlling for admission SCI-ARMI and the time from SCL onset to the examination, the effect of the country on ability realization gain was found non-significant (P = 0.086). CONCLUSION The study confirmed that rehabilitation makes a net contribution to improvement in performance in patients with SCL, beyond the contribution of neurological recovery. After controlling for affecting factors, this contribution was quite similar in the participating units from different countries.
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Affiliation(s)
- Vadim Bluvshtein
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amiram Catz
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ilana Gelernter
- School of Mathematical Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Adi Kfir
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - Lilach Front
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - Dianne Michaeli
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
| | | | | | | | - Nur Kesiktas
- Istanbul Physical Medicine and Rehabilitation Hospital, University of Health Sciences, Turkiye
| | - Elena Aidinoff
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Tsoy N, Langewitz W, Müri S, Notter S, Pannek J, Post MWM, Rednic LN, Rubinelli S, Scheel-Sailer A. Quality of life from the patient perspective at the end of the first rehabilitation after the onset of spinal cord injury/disorder - A qualitative interview-based study. J Spinal Cord Med 2023:1-12. [PMID: 37819653 DOI: 10.1080/10790268.2023.2263235] [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: 10/13/2023] Open
Abstract
CONTEXT At present, there is a lack of information concerning patients' perspectives on their quality of life (QoL) after a recently acquired spinal cord injury/disorder (SCI/D). OBJECTIVE To explore patients' perspectives on their QoL during their first inpatient rehabilitation after the onset of SCI/D. METHODS Qualitative study. Semi-structured face-to-face interviews were conducted with 20 participants aged 18 years or older at least three months after the onset of SCI/D and two weeks before they were discharged from their first rehabilitation. Audio-recorded interviews were transcribed and analyzed according to the thematic content analysis. Interviewees rated their QoL with the SCI QoL data set. RESULTS The interviewees judged their satisfaction with life as a whole, their physical and mental health, as relatively high with values between six and eight (with 10 meaning complete satisfaction). They highlighted social aspects, health topics, and the experience of autonomy as relevant to their concept of QoL. The aspects that positively influenced QoL included the level of well-being in the current social and institutional environment, the increased level of energy, strength, and autonomy in daily life, and an improved mental state derived from general positive personal attitudes. In contrast, the social restrictions during the COVID-19 pandemic, physical issues including pain, a lack of progress associated with psychological dissatisfaction, and limitations in personal independence decreased patients' QoL. CONCLUSION Since the interviewees described different aspects from the areas of social, health and autonomy as important for their QoL, exploring and addressing these areas should be used to achieve an individualized first rehabilitation.
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Affiliation(s)
| | - Wolf Langewitz
- Basel University Hospital, Psychosomatic Medicine - Communication in Medicine, Basel, Switzerland
| | - Selina Müri
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Seraina Notter
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Jürgen Pannek
- Swiss Paraplegic Centre, Nottwil, Switzerland
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marcel W M Post
- University of Groningen, University Medical Centre Groningen, Department of rehabilitation medicine, Groningen, the Netherlands
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | | | - Sara Rubinelli
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Anke Scheel-Sailer
- Swiss Paraplegic Centre, Nottwil, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Heuer A, Koepke LG, Viezens L, Schroeder M. [Perioperative management after traumatic paraplegia : Avoiding complications]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:749-755. [PMID: 37306757 DOI: 10.1007/s00113-023-01342-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/13/2023]
Abstract
This article describes the current status of modern treatment options for traumatic spinal cord injuries with a particular focus on the perioperative phase. Along with a recognition of age-related specific features that can impact successful treatment of spinal injuries, prompt interdisciplinary treatment while adhering to the "time is spine" principle is of high importance. By considering this approach and using modern diagnostic and surgical techniques, successful surgical treatment can be achieved while taking into account individual characteristics, such as reduced bone quality, accompanying injuries as well as oncological and inflammatory rheumatic comorbidities. The preventive and treatment strategies for frequently occurring complications in the management of traumatic spinal cord injuries are presented. By considering case-specific factors, utilizing modern surgical techniques, avoiding or promptly treating typical complications and initiating interdisciplinary treatment, crucial groundwork for a successful long-term treatment of this highly debilitating and life-altering injury can be established in the perioperative phase.
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Affiliation(s)
- Annika Heuer
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Sektion Wirbelsäulenchirurgie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Leon-Gordian Koepke
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Sektion Wirbelsäulenchirurgie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Lennart Viezens
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Sektion Wirbelsäulenchirurgie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - Malte Schroeder
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Sektion Wirbelsäulenchirurgie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
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Pelc M, Vilimkova Kahankova R, Blaszczyszyn M, Mikolajewski D, Konieczny M, Khoma V, Bara G, Zygarlicki J, Martinek R, Gupta MK, Gorzelanczyk EJ, Pawłowski M, Czapiga B, Zygarlicka M, Kawala-Sterniuk A. Initial study on an expert system for spine diseases screening using inertial measurement unit. Sci Rep 2023; 13:10440. [PMID: 37369726 PMCID: PMC10300108 DOI: 10.1038/s41598-023-36798-7] [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: 11/24/2022] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
In recent times, widely understood spine diseases have advanced to one of the most urgetn problems where quick diagnosis and treatment are needed. To diagnose its specifics (e.g. to decide whether this is a scoliosis or sagittal imbalance) and assess its extend, various kind of imaging diagnostic methods (such as X-Ray, CT, MRI scan or ST) are used. However, despite their common use, some may be regarded as (to a level) invasive methods and there are cases where there are contraindications to using them. Besides, which is even more of a problem, these are very expensive methods and whilst their use for pure diagnostic purposes is absolutely valid, then due to their cost, they cannot rather be considered as tools which would be equally valid for bad posture screening programs purposes. This paper provides an initial evaluation of the alternative approach to the spine diseases diagnostic/screening using inertial measurement unit and we propose policy-based computing as the core for the inference systems. Although the methodology presented herein is potentially applicable to a variety of spine diseases, in the nearest future we will focus specifically on sagittal imbalance detection.
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Affiliation(s)
- Mariusz Pelc
- Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, 45-758, Opole, Poland.
- School of Computing and Mathematical Sciences, University of Greenwich, London, SE10 9LS, UK.
| | - Radana Vilimkova Kahankova
- Faculty of Electrical Engineering and Computer Science, VSB-Technical University of Ostrava, Ostrava-Poruba, Czech Republic
| | - Monika Blaszczyszyn
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, 45-758, Opole, Poland
| | - Dariusz Mikolajewski
- Faculty of Computer Science, Kazimierz Wielki University, 85-064, Bydgoszcz, Poland
| | - Mariusz Konieczny
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, 45-758, Opole, Poland
| | - Volodymir Khoma
- Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, 45-758, Opole, Poland
- Lviv Polytechnic National University, Institute of Computer Technologies, Automation and Metrology, Lviv, Ukraine
| | - Gregor Bara
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Jaroslaw Zygarlicki
- Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, 45-758, Opole, Poland
| | - Radek Martinek
- Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, 45-758, Opole, Poland
- Faculty of Electrical Engineering and Computer Science, VSB-Technical University of Ostrava, Ostrava-Poruba, Czech Republic
| | - Munish K Gupta
- Faculty of Mechanical Engineering, Opole University of Technology, 45-271, Opole, Poland
- Department of Mechanical Engineering, Graphic Era University, Dehradun, India
| | - Edward Jacek Gorzelanczyk
- Faculty of Philosophy, Kazimierz Wielki University, Bydgoszcz, 85-092, Poland
- Faculty of Mathematics and Computer Science, Adam Mickiewicz University in Poznan, Poznan, 61-614, Poland
- Department of Theoretical Basis of Biomedical Sciences and Medical Informatics, Nicolaus Copernicus University, Collegium Medicum, 85-067, Bydgoszcz, Poland
- The Society for the Substitution Treatment of Addiction "Medically Assisted Recovery", 85-791, Bydgoszcz, Poland
- Psychiatric Department of Children and Adolescents Psychiatric Center in Warta, 98-290, Warta, Poland
| | - Mateusz Pawłowski
- Faculty of Health Sciences, Wroclaw Medical University, Wrocław, Poland
- Department of Neurosurgery, "Vital Medic" Hospital, Kluczbork, Poland
| | - Bogdan Czapiga
- Department of Neurosurgery, 4th Military Hospital in Wrocław, Wrocław, Poland
| | - Malgorzata Zygarlicka
- Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, 45-758, Opole, Poland
| | - Aleksandra Kawala-Sterniuk
- Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, 45-758, Opole, Poland.
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Kalyani P, Manasa Y, Ahammad SH, Suman M, Anwer TMK, Hossain MA, Rashed ANZ. Prediction of patient's neurological recovery from cervical spinal cord injury through XGBoost learning approach. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:2140-2148. [PMID: 37060466 DOI: 10.1007/s00586-023-07712-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/07/2023] [Accepted: 04/06/2023] [Indexed: 04/16/2023]
Abstract
Due to the diversity of patient characteristics, therapeutic approaches, and radiological findings, it can be challenging to predict outcomes based on neurological consequences accurately within cervical spinal cord injury (SCI) entities and based on machine learning (ML) technique. Accurate neurological outcomes prediction in the patients suffering with cervical spinal cord injury is challenging due to heterogeneity existing in patient characteristics and treatment strategies. Machine learning algorithms are proven technology for achieving greater prediction outcomes. Thus, the research employed machine learning model through extreme gradient boosting (XGBoost) for attaining superior accuracy and reliability followed with other MI algorithms for predicting the neurological outcomes. Besides, it generated a model of a data-driven approach with extreme gradient boosting to enhance fault detection techniques (XGBoost) efficiency rate. To forecast improvements within functionalities of neurological systems, the status has been monitored through motor position (ASIA [American Spinal Injury Association] Impairment Scale [AIS] D and E) followed by the method of prediction employing XGBoost, combined with decision tree for regression logistics. Thus, with the proposed XGBoost approach, the enhanced accuracy in reaching the outcome is 81.1%, and from other models such as decision tree (80%) and logistic regression (82%), in predicting outcomes of neurological improvements within cervical SCI patients. Considering the AUC, the XGBoost and decision tree valued with 0.867 and 0.787, whereas logistic regression showed 0.877. Therefore, the application of XGBoost for accurate prediction and decision-making in the categorization of pre-treatment in patients with cervical SCI has reached better development with this study.
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Affiliation(s)
- P Kalyani
- Department of ECE, Vardhaman College of Engineering, Hyderabad, India
| | - Y Manasa
- Department of CSE, Prasad V Potluri Siddhartha Institute of Technology, Vijayawada, India
| | - Sk Hasane Ahammad
- Department of ECE, Koneru Lakshmaiah Education Foundation, Vaddeswaram, 522302, India
| | - M Suman
- Department of ECE, Koneru Lakshmaiah Education Foundation, Vaddeswaram, 522302, India
| | - Twana Mohammed Kak Anwer
- Department of Physics, College of Education, Salahaddin University-Erbil, Erbil, Kurdistan Region, 44002, Iraq
| | - Md Amzad Hossain
- Institute of Theoretical Electrical Engineering, Faculty of Electrical Engineering and Information Technology, Ruhr University Bochum, 44801, Bochum, Germany.
- Department of Electrical and Electronic Engineering, Jashore University of Science and Technology, Jashore, 7408, Bangladesh.
| | - Ahmed Nabih Zaki Rashed
- Electronics and Electrical Communications Engineering Department, Faculty of Electronic Engineering, Menoufia University, Menouf, 32951, Egypt.
- Department of VLSI Microelectronics, Institute of Electronics and Communication Engineering, Saveetha School of Engineering, SIMATS, Chennai, Tamilnadu, 602105, India.
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Vijay P, Sureka RK. Development, Content Validity and Reliability of Upper Extremity Functional Skill Measure in C5-C7 Spinal Cord Injury. Cureus 2023; 15:e37599. [PMID: 37197110 PMCID: PMC10184714 DOI: 10.7759/cureus.37599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 04/13/2023] [Indexed: 05/19/2023] Open
Abstract
STUDY DESIGN A methodological research design. OBJECTIVE To create an objective measure for assessing hand functions in C5-C7 spinal cord injury (SCI) and estimation of its content validity and internal consistency reliability. METHOD This study was executed in three phases. Phase 1 included a thorough review of the literature, semi-structured in-depth interviews of participants with tetraplegia and interviews of caregivers of SCI individuals and healthcare workers dealing with SCI to understand the hand functions of individuals with C5-C7 SCI. Phase 2 consisted of the development of the tool. The content validity ratio (CVR) method and the opinion of the expert validated the content of the upper extremity functional skill measure (UEFSM). Phase 3 included a quantitative evaluation of the tool which was done on a targeted group of 30 subjects with C5-C7 SCI. RESULTS Through the review of the literature and in-depth interview of the participants, 11 items were developed under four content areas: grasp, grip, pinch and gross movement. Items with a minimum CVR of 0.56 were retained at a significance level of p = 0.05 resulting in a 10-item tool for assessing the hand function of individuals with C5-C7 SCI categorized under four subscales. Pilot testing on 10 subjects reveals an average time of 2 minutes and 25 seconds to complete the task. The Cronbach's alpha was found to be 0.878. CONCLUSION UEFSM is a 10-item tool with good content validity and internal consistency reliability for the assessment of hand functions in individuals with C5-C7 SCI.
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Affiliation(s)
- Priyanka Vijay
- Department of Occupational Therapy, Mahatma Gandhi Occupational Therapy College, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, IND
| | - Rajendra Kumar Sureka
- Department of Neurology, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, IND
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Gil-Agudo Á, Megía-García Á, Pons JL, Sinovas-Alonso I, Comino-Suárez N, Lozano-Berrio V, Del-Ama AJ. Exoskeleton-based training improves walking independence in incomplete spinal cord injury patients: results from a randomized controlled trial. J Neuroeng Rehabil 2023; 20:36. [PMID: 36964574 PMCID: PMC10039497 DOI: 10.1186/s12984-023-01158-z] [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: 03/14/2022] [Accepted: 03/10/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND In recent years, ambulatory lower limb exoskeletons are being gradually introduced into the clinical practice to complement walking rehabilitation programs. However, the clinical evidence of the outcomes attained with these devices is still limited and nonconclusive. Furthermore, the user-to-robot adaptation mechanisms responsible for functional improvement are still not adequately unveiled. This study aimed to (1) assess the safety and feasibility of using the HANK exoskeleton for walking rehabilitation, and (2) investigate the effects on walking function after a training program with it. METHODS A randomized controlled trial was conducted including a cohort of 23 patients with less than 1 year since injury, neurological level of injury (C2-L4) and severity (American Spinal Cord Injury Association Impairment Scale [AIS] C or D). The intervention was comprised of 15 one-hour gait training sessions with lower limb exoskeleton HANK. Safety was assessed through monitoring of adverse events, and pain and fatigue through a Visual Analogue Scale. LEMS, WISCI-II, and SCIM-III scales were assessed, along with the 10MWT, 6MWT, and the TUG walking tests (see text for acronyms). RESULTS No major adverse events were reported. Participants in the intervention group (IG) reported 1.8 cm (SD 1.0) for pain and 3.8 (SD 1.7) for fatigue using the VAS. Statistically significant differences were observed for the WISCI-II for both the "group" factor (F = 16.75, p < 0.001) and "group-time" interactions (F = 8.87; p < 0.01). A post-hoc analysis revealed a statistically significant increase of 3.54 points (SD 2.65, p < 0.0001) after intervention for the IG but not in the CG (0.7 points, SD 1.49, p = 0.285). No statistical differences were observed between groups for the remaining variables. CONCLUSIONS The use of HANK exoskeleton in clinical settings is safe and well-tolerated by the patients. Patients receiving treatment with the exoskeleton improved their walking independence as measured by the WISCI-II after the treatment.
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Affiliation(s)
- Ángel Gil-Agudo
- Biomechanics and Technical Aids Department, National Hospital for Paraplegics, SESCAM, Finca la Peraleda s/n, 45071, Toledo, Spain.
- Physical Medicine and Rehabilitation Department, National Hospital for Paraplegics, SESCAM, Toledo, Spain.
- Neurorehabilitation and Biomechanics Unit (HNP-SESCAM), Associate Unit CSIC, Toledo, Spain.
| | - Álvaro Megía-García
- Biomechanics and Technical Aids Department, National Hospital for Paraplegics, SESCAM, Finca la Peraleda s/n, 45071, Toledo, Spain
- Physical Medicine and Rehabilitation Department, National Hospital for Paraplegics, SESCAM, Toledo, Spain
- Neurorehabilitation and Biomechanics Unit (HNP-SESCAM), Associate Unit CSIC, Toledo, Spain
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursing, Castilla La Mancha University, Toledo, Spain
| | - José Luis Pons
- Legs and Walking Lab, Shirley Ryan Ability Laboratory (Formerly Rehabilitation Institute of Chicago), Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Biomedical Engineering, McCormick School of Engineering and Applied Science, Northwestern University, Chicago, IL, USA
- Department of Mechanical Engineering, McCormick School of Engineering and Applied Science, Northwestern University, Chicago, IL, USA
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
| | - Isabel Sinovas-Alonso
- Biomechanics and Technical Aids Department, National Hospital for Paraplegics, SESCAM, Finca la Peraleda s/n, 45071, Toledo, Spain
- Physical Medicine and Rehabilitation Department, National Hospital for Paraplegics, SESCAM, Toledo, Spain
- Neurorehabilitation and Biomechanics Unit (HNP-SESCAM), Associate Unit CSIC, Toledo, Spain
| | - Natalia Comino-Suárez
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursing, Castilla La Mancha University, Toledo, Spain
| | - Vicente Lozano-Berrio
- Biomechanics and Technical Aids Department, National Hospital for Paraplegics, SESCAM, Finca la Peraleda s/n, 45071, Toledo, Spain
- Physical Medicine and Rehabilitation Department, National Hospital for Paraplegics, SESCAM, Toledo, Spain
- Neurorehabilitation and Biomechanics Unit (HNP-SESCAM), Associate Unit CSIC, Toledo, Spain
| | - Antonio J Del-Ama
- Biomechanics and Technical Aids Department, National Hospital for Paraplegics, SESCAM, Finca la Peraleda s/n, 45071, Toledo, Spain
- Physical Medicine and Rehabilitation Department, National Hospital for Paraplegics, SESCAM, Toledo, Spain
- Neurorehabilitation and Biomechanics Unit (HNP-SESCAM), Associate Unit CSIC, Toledo, Spain
- Rey Juan Carlos University, Electronic Technology Area, Móstoles, Spain
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Independence and upper extremity functioning after spinal cord injury: a cross-sectional study. Sci Rep 2023; 13:3148. [PMID: 36823179 PMCID: PMC9950049 DOI: 10.1038/s41598-023-29986-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 02/14/2023] [Indexed: 02/25/2023] Open
Abstract
Upper extremity functioning is important for achieving independence in activities of daily living (ADL). A better understanding of relationships between different aspects of independence in ADL after spinal cord injury (SCI) and upper extremity functioning is required to guide rehabilitation practices. To determine which aspects of independence in ADL are correlated with upper extremity functioning in individuals with cervical or thoracic SCI. A total of 25 adults (mean age 58.4 years, 72% men) with established cervical or thoracic SCI were recruited. Independence in ADL was assessed by Spinal Cord Independence Measure (SCIM-III) and upper extremity functioning by kinematic measures (movement time, smoothness, and wrist angle during drinking task), grip strength, Upper Extremity Motor and Sensory Score, Box and Block Test (BBT), Action Research Arm Test (ARAT), and Upper Extremity Basic Data Set (ISCI-Hand and ISCI-Shoulder). Spearman correlation coefficients were used for data analyses. The SCIM-self-care subscale, particularly the feeding and dressing items, correlated moderately (r ≥ 0.5) with movement time and smoothness, grip strength, ARAT, BBT, and ISCI-Hand. The SCIM-respiration/sphincter subscale and the SCIM-mobility showed very low and low correlations with upper extremity assessments. However, at item level, respiration and bed/wheelchair mobility showed moderate correlations. Independence in self-care as domain and feeding/dressing, respiration and bed/wheelchair mobility as separate items were dependent on upper extremity functioning in individuals with cervical or thoracic SCI. Movement time and smoothness along with BBT, grip strength, ARAT, and ISCI-Hand can be used as indicators of independence in ADL. These findings can provide guidance to clinical practice in selection of upper extremity assessments in the context for ADL in individuals with SCI.
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14
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Oraee-Yazdani S, Tavanaei R, Rezaee-Naserabad SS, Khannejad S, Alizadeh Zendehrood S, Yazdani KO, Zali A. Safety and Potential Efficacy of Selective Dorsal Rhizotomy in Adults with Spinal Cord Injury-Induced Spasticity: An Open-Label, Non-Randomized, Single-Arm Trial. World Neurosurg 2023; 170:e806-e816. [PMID: 36460198 DOI: 10.1016/j.wneu.2022.11.127] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Despite the abundant literature on the use of selective dorsal rhizotomy (SDR) in spastic cerebral palsy, no investigation has evaluated its use in adult patients with chronic spinal cord injury (SCI)-induced spasticity. The present investigation aimed to evaluate the safety and potential efficacy of SDR in chronic SCI-induced spasticity for the first time. METHODS In this open-label, single-arm, non-randomized clinical trial, all patients were assigned to the single study intervention arm and underwent SDR. The primary outcome measure was the safety profile of SDR. Secondary outcome measures were Modified Ashworth Scale, Penn Spasm Frequency Scale, visual analog scale for spasticity, Spinal Cord Injury Spasticity Tool, Spinal Cord Independence measure version III, and Short Form 36 Health Survey Questionnaire. RESULTS Six patients with cervical SCI and 4 with thoracic SCI were allocated to the single study intervention arm. No adverse event attributable to the SDR was found. Moreover, all secondary outcome measures of the study improved significantly over the study period (P < 0.001). Multiple regression analysis also found a significant association between level of injury and changes in average Modified Ashworth Scale scores (P = 0.041), Spinal Cord Injury Spasticity Tool score (P = 0.013), and Spinal Cord Independence measure version III total (P = 0.002) and mobility domain scores (P = 0.004) at 12-month postoperatively. CONCLUSIONS This clinical trial indicated that SDR is a safe and potentially effective procedure in patients with severe and intractable SCI-induced spasticity. However, future clinical trials with larger sample sizes and adequate power are required to validate our findings regarding efficacy.
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Affiliation(s)
- Saeed Oraee-Yazdani
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Roozbeh Tavanaei
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyyed Saeed Rezaee-Naserabad
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samin Khannejad
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Siamak Alizadeh Zendehrood
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kaveh Oraii Yazdani
- Department of cardiovascular diseases, Zahedan University of Medical Science, Zahedan, Iran
| | - Alireza Zali
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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15
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Chen JM, Li XL, Pan QH, Yang Y, Xu SM, Xu JW. Effects of non-invasive brain stimulation on motor function after spinal cord injury: a systematic review and meta-analysis. J Neuroeng Rehabil 2023; 20:3. [PMID: 36635693 PMCID: PMC9837916 DOI: 10.1186/s12984-023-01129-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 01/07/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND In recent years, non-invasive brain stimulation (NIBS) has been used for motor function recovery. However, the effects of NIBS in populations with spinal cord injury (SCI) remain unclear. This study aims to conduct a meta-analysis of the existing evidence on the effects and safety of NIBS against sham groups for motor dysfunction after SCI to provide a reference for clinical decision-making. METHODS Two investigators systematically screened English articles from PubMed, MEDLINE, Embase, and Cochrane Library for prospective randomized controlled trials regarding the effects of NIBS in motor function recovery after SCI. Studies with at least three sessions of NIBS were included. We assessed the methodological quality of the selected studies using the evidence-based Cochrane Collaboration's tool. A meta-analysis was performed by pooling the standardized mean difference (SMD) with 95% confidence intervals (CI). RESULTS A total of 14 randomized control trials involving 225 participants were included. Nine studies used repetitive transcranial magnetic stimulation (rTMS) and five studies used transcranial direct current stimulation (tDCS). The meta-analysis showed that NIBS could improve the lower extremity strength (SMD = 0.58, 95% CI = 0.02-1.14, P = 0.004), balance (SMD = 0.64, 95% CI = 0.05-1.24, P = 0.03), and decrease the spasticity (SMD = - 0.64, 95% CI = - 1.20 to - 0.03, P = 0.04). However, the motor ability of the upper extremity in the NIBS groups was not statistically significant compared with those in the control groups (upper-extremity strength: P = 0.97; function: P = 0.56; and spasticity: P = 0.12). The functional mobility in the NIBS groups did not reach statistical significance when compared with the sham NIBS groups (sham groups). Only one patient reported seizures that occurred during stimulation, and no other types of serious adverse events were reported. CONCLUSION NIBS appears to positively affect the motor function of the lower extremities in SCI patients, despite the marginal P-value and the high heterogeneity. Further high-quality clinical trials are needed to support or refute the use and optimize the stimulation parameters of NIBS in clinical practice.
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Affiliation(s)
- Jian-Min Chen
- grid.412594.f0000 0004 1757 2961Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China ,grid.412683.a0000 0004 1758 0400Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xiao-Lu Li
- grid.412594.f0000 0004 1757 2961Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Qin-He Pan
- grid.412594.f0000 0004 1757 2961Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Ye Yang
- grid.412594.f0000 0004 1757 2961Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Sen-Ming Xu
- grid.412594.f0000 0004 1757 2961Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Jian-Wen Xu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China.
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Powers MB, Douglas ME, Driver S, Sikka S, Hamilton R, Swank C, Callender L, Ochoa C, Bennett M, Stewart N, Chauvin GV, Rothbaum BO, Warren AM. Prevention of posttraumatic stress during inpatient rehabilitation post spinal cord injury: Study protocol for a randomized controlled trial of Brief Prolonged Exposure Therapy (Brief PE). Contemp Clin Trials Commun 2022; 30:101030. [PMID: 36387992 PMCID: PMC9661669 DOI: 10.1016/j.conctc.2022.101030] [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: 06/02/2022] [Revised: 10/20/2022] [Accepted: 10/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Scant research has focused on posttraumatic stress disorder (PTSD) in the SCI population, despite high prevalence estimates. Fortunately, prolonged exposure therapy (PE) is a well-researched and highly effective treatment for PTSD. Our recent clinical trial showed that standard 12-session PE was effective for PTSD treatment among inpatients with SCI. Early intervention with brief PE (3-sessions) delivered in the emergency department has also been effective for PTSD prevention, but has not been tested among people post-SCI. Thus, we aim to conduct the first test of the Brief PE intervention to prevent PTSD among patients with SCI. Methods Adults who have experienced a SCI (N = 200) will be randomly assigned during inpatient rehabilitation to either: (a) 3 60-min sessions of Brief PE (intervention group) or (b) treatment as usual (control group). Results The primary outcome measure (PTSD symptoms measured by the PSSI-5) and secondary outcome measures (depression, anxiety, pain, quality of life, sleep disturbance, and resilience) will be assessed at baseline, 1-month, 3-months, and 6-months. Hierarchical linear modeling (HLM) will be used to evaluate the effectiveness of the PE intervention on PTSD and secondary outcomes. Descriptive statistics will examine feasibility and will include the number of participants enrolled, the number of sessions completed, fidelity of Brief PE delivery, and average scores for difficulty and helpfulness of the intervention scales for those randomized to intervention. Conclusions Successful completion of this study will provide an evidence-based program to alleviate posttraumatic distress post spinal cord injury and prevent long-term development of PTSD.
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Affiliation(s)
- Mark B. Powers
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Corresponding author. Baylor Scott & White Spinal Cord Injury Model System, USA.
| | - Megan E. Douglas
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Simon Driver
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Seema Sikka
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Rita Hamilton
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Chad Swank
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Librada Callender
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Christa Ochoa
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Monica Bennett
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Neil Stewart
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Gregory V. Chauvin
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Barbara O. Rothbaum
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Emory University School of Medicine, USA
| | - Ann Marie Warren
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
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Pavese C, Scivoletto G, Puci MV, Abel R, Curt A, Maier D, Rupp R, Schubert M, Weidner N, Montomoli C, Kessler TM. Prediction of bowel management independence after ischemic spinal cord injury. Eur J Phys Rehabil Med 2022; 58:709-714. [PMID: 35666490 PMCID: PMC10019474 DOI: 10.23736/s1973-9087.22.07366-x] [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: 11/08/2022]
Abstract
BACKGROUND Ischemic spinal cord injury (SCI) belongs to the heterogeneous group of non-traumatic SCI, while the course of sensorimotor and functional recovery is comparable to traumatic SCI. Recently, we derived from data of patients with traumatic SCI a valid model to predict an independent and reliable bowel management one year after SCI. AIM To evaluate the performance of this model to predict an independent and reliable bowel management one year following ischemic SCI. DESIGN Prognostic study - observational study. SETTING European Multicenter Study about Spinal Cord Injury (EMSCI) ClinicalTrials.gov: NCT01571531. POPULATION One hundred and forty-two patients with ischemic SCI of various level and severity of injury. METHODS The prediction model relied on a single predictor collected within 40 days from injury, the International Standards for Neurological Classification of Spinal Cord Injury total motor score. Bowel outcome one year after SCI derived from the dichotomization of the Spinal Cord Independence Measure (SCIM) item 7 scores. We defined a positive outcome as independent bowel management with regular movements and appropriate timing with no or rare accidents (score of 10 in SCIM version II and score of 8 or 10 in version III). RESULTS The model showed a fair discrimination with an area under the receiver operating characteristic (ROC) curve of 0.780 (95% confidence interval=0.702-0.860). In addition, the model displayed an acceptable accuracy and calibration. CONCLUSIONS The study extends the validity of our rule to patients with ischemic SCI, thus providing the first model to predict an independent and reliable bowel management in this population. CLINICAL REHABILITATION IMPACT The model may be employed in clinical practice to counsel patients, to define the rehabilitation aims and to estimate the need of assistance after discharge, as well as in the research field for the optimization of patients' allocation in the design of future clinical trials.
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Affiliation(s)
- Chiara Pavese
- Department of Neurology, Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation and Spinal Unit, Pavia Institute, Pavia, Italy
| | - Giorgio Scivoletto
- Spinal Cord Unit and Spinal Rehabilitation (SpiRe) Lab, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Mariangela V Puci
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Rainer Abel
- Spinal Cord Injury Center, Hohe Warte, Bayreuth, Germany
| | - Armin Curt
- Department of Neurology, Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | | | - Rüdiger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Schubert
- Department of Neurology, Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Cristina Montomoli
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland -
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Hindi translation and reliability testing of the international spinal cord injury quality of life basic data set version 1.0. Spinal Cord 2022; 60:784-788. [PMID: 35304568 DOI: 10.1038/s41393-022-00785-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 01/22/2023]
Abstract
STUDY DESIGN Methodological study design: translation and test-retest reliability testing. OBJECTIVES To translate International Spinal Cord Injury Quality of Life Basic Data Set (ISCIQoLBDS) Version 1.0 into Hindi language and conduct reliability testing of Hindi ISCIQoLBDS (hISCIQoLBDS). SETTING The study was conducted at Indian Spinal Injuries Centre, New Delhi, India. METHODS The study was done in two phases-translation of ISCIQoLBDS Version 1.0 into Hindi language and reliability testing of hISCIQoLBDS. In the translation phase, the data set was forward translated by two independent professional translators. Then backward translation was done by another pair of professional translators to ensure the essence of the data set. For their feedback, field testing of hISCIQoLBDS was done on ten individuals with Spinal Cord Injury (SCI). After this, an expert panel reviewed their recommendations, and the final hISCIQoLBDS was administered on 50 participants with SCI for test-retest reliability of the data set. RESULTS hISCIQoLBDS was found to be equivalent to ISCIQoLBDS Version 1.0 on back-translation. It showed high test-retest reliability for each item in the data set. Intraclass Correlation Coefficient (95% CI) for items of hISCIQoLBDS was within the range of (0.91-0.98). CONCLUSION The hISCIQoLBDS is a stepwise systematic Hindi translation of the ISCIQoLBDS Version 1.0 for the Hindi literate population with high test-retest reliability. It can facilitate international data exchange on the quality of life (QoL) of Hindi literate individuals with SCI.
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Lampart P, Schäppi L, Langewitz WA, Rubinelli S, Sigrist-Nix D, Scheel-Sailer A. Health care professionals’ experiences with goal setting during initial rehabilitation after newly acquired spinal cord injury/ disorder – a qualitative focus group study. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:982321. [PMID: 36189066 PMCID: PMC9397958 DOI: 10.3389/fresc.2022.982321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022]
Abstract
IntroductionGoal setting (GS) is an important aspect of initial spinal cord injury/ disorder (SCI/D) rehabilitation. However, because expected outcomes are individual and often difficult to determine, GS is not straightforward. The aim of this study was to explore the health care professionals' (HCP's) experiences with and perspectives on the goal-setting process (GSP) during initial SCI/D rehabilitation.MethodFive semi-structured focus groups (FG) (22 purposively sampled HCP, mostly in leadership positions, six different professions). The FG were transcribed verbatim. We analyzed the transcripts for qualitative content analysis following Braun and Clarke (2013).ResultsHCP described GS-influencing aspects at the macro, meso and micro levels. At the macro level, participants spoke about restrictions imposed by health insurers or difficulties in planning the post-inpatient setting. Regarding the meso level, HCP spoke of institutional structures and culture that facilitated the GSP. At the micro level, knowledge of the diagnosis, expected outcomes, and individual patient characteristics were mentioned as important to the rehabilitation process. It was important for HCP to be patient and empathetic, to endure negative emotions, to accept that patients need time to adjust to their new situation, and to ensure that they do not lose hope. Open communication and interprofessional collaboration helped overcome barriers in the GSP.DiscussionThis paper shows the complex relationship between external (e.g., health insurers), emotional, and communication aspects. It calls for a comprehensive approach to optimizing the GSP, so that patients' experiences can be fully considered as a basis to identify the most appropriate care pathway.
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Affiliation(s)
- Patricia Lampart
- Swiss Paraplegic Center, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Livia Schäppi
- Swiss Paraplegic Center, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Sara Rubinelli
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | | | - Anke Scheel-Sailer
- Swiss Paraplegic Center, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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How Is Spinal Cord Function Measured in Degenerative Cervical Myelopathy? A Systematic Review. J Clin Med 2022; 11:jcm11051441. [PMID: 35268533 PMCID: PMC8910882 DOI: 10.3390/jcm11051441] [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: 01/19/2022] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 12/10/2022] Open
Abstract
Degenerative cervical myelopathy (DCM) is a prevalent condition in which spinal degeneration causes cord compression and neurological dysfunction. The spinal cord is anatomically complex and operates in conjunction with the brain, the musculoskeletal system, and numerous organs to control numerous functions, including simple and coordinated movement, sensation, and autonomic functions. As a result, accurate and comprehensive measurement of spinal cord function in patients with DCM and other spinal pathologies is challenging. This project aimed to summarize the neurological, functional, and quality of life (QoL) outcome measures currently in use to quantify impairment in DCM. A systematic review of the literature was performed to identify prospective studies with at least 100 DCM subjects that utilized one or more quantitative neurological, functional, or QoL outcome measures. A total of 148 studies were identified. The most commonly used instruments were subjective functional scales including the Japanese Orthopedic Association (JOA) (71 studies), modified JOA (mJOA) (66 studies), Neck Disability Index (NDI) (54 studies), and Nurick (39 studies), in addition to the QoL measure Short-Form-36 (SF-36, 52 studies). A total of 92% (320/349) of all outcome measures were questionnaires, whereas objective physical testing of neurological function (strength, gait, balance, dexterity, or sensation) made up 8% (29/349). Studies utilized an average of 2.36 outcomes measures, while 58 studies (39%) utilized only a single outcome measure. No studies were identified that specifically assessed the dorsal column sensory pathway or respiratory, bowel, or sexual function. In the past five years, there were no significant differences in the number of total, functional, or QoL outcome measures used, but physical testing of neurological function has increased (p = 0.005). Prior to 2017, cervical spondylotic myelopathy (CSM) was the most frequently used term to describe the study population, whereas in the last five years, DCM has become the preferred terminology. In conclusion, clinical studies of DCM typically utilize limited data to characterize impairment, often relying on subjective, simplistic, and non-specific measures that do not reflect the complexity of the spinal cord. Although accurate measurement of impairment in DCM is challenging, it is necessary for early diagnosis, monitoring for deterioration, and quantifying recovery after therapeutic interventions. Clinical decision-making and future clinical studies in DCM should employ a combination of subjective and objective assessments to capture the multitude of spinal cord functions to improve clinical management and inform practice guidelines.
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Ikbali Afsar S, Cosar SNS, Yemişçi OU, Bölük H. Inpatient rehabilitation outcomes in neoplastic spinal cord compression vs. traumatic spinal cord injury. J Spinal Cord Med 2022; 45:221-229. [PMID: 32701391 PMCID: PMC8986217 DOI: 10.1080/10790268.2020.1794713] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Objective: To compare neurological and functional outcomes, and complications of patients with neoplastic vs traumatic spinal cord injury (SCI) after in-patient rehabilitation.Design: This study is a retrospective analysis.Setting: In-patient rehabilitation unit of a tertiary research hospital.Participants: A total of 252 patients with a SCI were included; 43 with neoplastic SCI (mean age: 60.9 ± 15.7 years, 60.5% were males) and 209 with traumatic SCI (mean age: 43.1 ± 16.8 years, 71.3% were males).Outcome measures: Comparisons were made of demographic characteristics, etiology, American Spinal Injury Association (ASIA) impairment scale, functional independence measurement (FIM) and Functional Ambulation Categories (FAC) scores, length of stay (LOS), bladder independence, medical comorbidities and complications in both groups.Results: Patients with neoplastic SCI were significantly older than those with traumatic SCI (P < 0.01). No difference was present between the groups in terms of sex and lesion level (P > 0.05). Incomplete SCI was significantly higher in the neoplastic group when compared with the traumatic group (P < 0.01). The LOS was significantly shorter in the neoplastic group than traumatic group (34.8 ± 41.03 vs. 60.02 ± 53.1, P < 0.01). There were no differences in the admission FIM scores (69.3 ± 24.7 vs. 58.7 ± 18.9, P > 0.05), discharge FIM scores (82.1 ± 25.1 vs. 74.02 ± 23.3, P > 0.05) and FIM efficiencies (0.43 ± 0.72 vs. 0.36 ± 0.51, P > 0.05) for the neoplastic and traumatic groups, respectively. However, neoplastic SCI patients demonstrated lower FIM gains compared to traumatic patients (12.9 ± 11.9 vs. 15.4 ± 15.2, P < 0.05). During rehabilitation, urinary tract infection (48.4% vs. 69.4%) and decubitus ulcer (11.6% vs. 35.9%) were significantly more common in the traumatic group than the neoplastic group (P < 0.05).Conclusion: Neoplastic SCI patients who commonly present at rehabilitation units exhibit different characteristics from traumatic SCI patients but the rehabilitation results are similar. Similar functional development can be achieved in a shorter period of time with inpatient rehabilitation in the neoplastic SCI group.
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Affiliation(s)
- Sevgi Ikbali Afsar
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Sacide Nur Saraçgil Cosar
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Oya Umit Yemişçi
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Hüma Bölük
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Baskent University, Ankara, Turkey
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Catz A, Itzkovich M, Elkayam K, Michaeli D, Gelernter I, Benjamini Y, Chhabra HS, Tesio L, Engel-Haber E, Bizzarini E, Pilati C, Popolo GD, Baroncini I, Liu N, Margalho P, Soeira TP, Chandy B, Joshi M, Lemay JF, Curran D, Leiulfsrud AS, Sørensen L, Biering-Sorensen F, Kesiktas N, Osman A, Bluvshtein V. Reliability validity and responsiveness of the spinal cord independence measure 4 th version in a multicultural setup. Arch Phys Med Rehabil 2021; 103:430-440.e1. [PMID: 34687675 DOI: 10.1016/j.apmr.2021.07.811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/21/2021] [Accepted: 07/27/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To examine the fourth version of the Spinal Cord Independence Measure for reliability and validity. DESIGN Partly blinded comparison with the criterion standard Spinal Cord Independence Measure III, and between examiners and examinations. SETTING A multicultural cohort from 19 spinal cord injury units in 11 countries. PARTICIPANTS Six hundred and forty-eight patients with spinal cord injury. INTERVENTION Assessment with Spinal Cord Independence Measure (SCIM IV) and Spinal Cord Independence Measure (SCIM III) on admission to inpatient rehabilitation and before discharge. MAIN OUTCOME MEASURES SCIM IV interrater reliability, internal consistency, correlation with and difference from SCIM III, and responsiveness. RESULTS Total agreement between examiners was above 80% on most SCIM IV tasks. All Kappa coefficients were above 0.70 and statistically significant (p<0.001). Pearson's coefficients of the correlation between the examiners were above 0.90, and intraclass correlation coefficients were above 0.90. Cronbach's alpha was above 0.96 for the entire SCIM IV, above 0.66 for the subscales, and usually decreased when an item was eliminated. Reliability values were lower for the subscale of respiration and sphincter management, and on admission than at discharge. SCIM IV and SCIM III mean values were very close, and the coefficients of Pearson correlation between them were 0.91-0.96 (p<0.001). The responsiveness of SCIM IV was not significantly different from that of SCIM III in most of the comparisons. CONCLUSIONS The validity, reliability, and responsiveness of SCIM IV, which was adjusted to assess specific patient conditions or situations that SCIM III does not address, and which includes more accurate definitions of certain scoring criteria, are very good and quite similar to those of SCIM III. SCIM IV can be used for clinical and research trials, including international multi-center studies, and its group scores can be compared with those of SCIM III.
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Affiliation(s)
- Amiram Catz
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Malka Itzkovich
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Keren Elkayam
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
| | - Dianne Michaeli
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
| | - Ilana Gelernter
- School of Mathematical Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Benjamini
- School of Mathematical Sciences, Tel Aviv University, Tel Aviv, Israel
| | | | - Luigi Tesio
- Istituto Auxologico Italiano, IRCCS, and Università degli Studi, Milan, Italy
| | - Einat Engel-Haber
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Neurological Rehabilitation, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | | | | | | | - Nan Liu
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | | | | | - Bobeena Chandy
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mrinal Joshi
- Department of Physical Medicine and Rehabilitation, Rehabilitation Research Center, SMS Medical College & Associated Hospitals, Jaipur, India
| | | | | | - Annelie Schedin Leiulfsrud
- St Olav University Hospital, Clinic of Physical Medicine and Rehabilitation, Department of Spinal Cord Injuries, Trondheim, Norway
| | - Linda Sørensen
- Department of Innovation, Technology and E-Health, Sunnaas Rehabilitation Hospital HF, Nesoddtangen, Norway
| | - Fin Biering-Sorensen
- Department of Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Denmark
| | - Nur Kesiktas
- Istanbul Physical Medicine and Rehabilitation University of Health Sciences, Turkey
| | - Aheed Osman
- Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Vadim Bluvshtein
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Eaton R, Duff J, Wallace M, Jones K. The value of the whole picture: rehabilitation outcome measurement using patient self-report and clinician-based assessments after spinal cord injury. Spinal Cord 2021; 60:71-80. [PMID: 34616008 DOI: 10.1038/s41393-021-00677-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 07/13/2021] [Accepted: 07/23/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN This is a retrospective longitudinal study. OBJECTIVES To explore the relative impact and contribution of using both the Spinal Cord Independence Measure III (SCIM) and Stoke Mandeville Spinal Needs Assessment Checklist (SMS-NAC) to assess rehabilitation outcome following an acute spinal cord injury (SCI). SETTING The study was performed at National Spinal Injuries Centre (NSIC), Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK. METHODS A patient self-report SMS-NAC and clinician-rated SCIM were administered on admission and discharge from the NSIC as part of standardised care. This paper presents a retrospective analysis of the rehabilitation outcomes of 195 people with spinal cord injury (PwSCI) following their first admission. RESULTS In both measures, PwSCI improved from admission to discharge. Individuals with higher SCI obtained lower scores in both measures, at both admission and discharge. The SMS-NAC demonstrated the greatest increase in knowledge and skill for PwSCI who had higher and more complete injuries. On the SCIM, PwSCI who had lower and less complete injuries demonstrated the greatest increase in outcome. CONCLUSIONS Overall, both measures demonstrated responsiveness to change during SCI rehabilitation and enable clinicians to systematically determine areas to focus rehabilitation effort. The relative strengths and contribution to delivering person-centred care for each are identified. The SMS-NAC enables clinicians to record, for people with higher injuries, their subjective self-report of skill and knowledge gains from rehabilitation that may be missed with other measures. Consequently, using both is encouraged in appreciation of the value of recording verbal (instructional) independence as well as functional (physical) independence.
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Affiliation(s)
- Rebecca Eaton
- NSIC, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
| | - Jane Duff
- NSIC, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK.
| | - Martha Wallace
- NSIC, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
| | - Kevin Jones
- NSIC, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
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Scheel-Sailer A, Lampart P, Selb M, Baumberger M, Gmünder HP, Sigrist-Nix D, Schmitt K, Stucki G. The Nottwil Standard-Development and Implementation of an International Classification of Functioning, Disability and Health-Based Clinical Standard Assessment for Post-acute Rehabilitation After Newly Acquired Spinal Cord Injury. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:720395. [PMID: 36188783 PMCID: PMC9397844 DOI: 10.3389/fresc.2021.720395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/17/2021] [Indexed: 12/02/2022]
Abstract
Introduction: Assessments during rehabilitation of spinal cord injury (SCI) align with the World Health Organization's classifications and national quality requirements. This paper aims to report on the development and first implementation experiences of an institutional standard of assessments performed after newly acquired SCI. Setting: Specialized SCI acute care and post-acute rehabilitation clinic in Switzerland. Methods: A situation analysis of an interdisciplinary post-acute SCI rehabilitation program was performed. The results informed a subsequent consensus-based selection of assessments, and an information and implementation strategy. Linking to the ICF Core Set for SCI in post-acute settings and ICF Generic-30 Set was performed. The Nottwil Standard was piloted for 18 months. Results: Situation analysis: A battery of 41 assessments were irregularly performed during initial rehabilitation after newly aquired SCI. Selection of assessments: A multidisciplinary group of clinicians agreed on 10 examinations, 23 assessments and two questionnaires that make up the Nottwil Standard. In total, 55 ICF categories are covered, including most of the ICF Generic-30 Set categories. The implementation strategy included Executive Board commitment, a structured improvement project, guidelines for documentation and assessments, a manual controlling system, and staff training on the Nottwil Standard. Pilot phase: 54 persons with paraplegia and 42 with tetraplegia (75 male; 21 female) were included. Twenty-seven assessments out of 33 assessments were performed in more than 80% of all observed patients' rehabilitation. Conclusion: Implementation of a standard assessment schedule was feasible but required a well-structured process with good communication strategy and controlling mechanism, and full engagement of involved professions.
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Affiliation(s)
- Anke Scheel-Sailer
- Swiss Paraplegic Centre, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- *Correspondence: Anke Scheel-Sailer
| | | | - Melissa Selb
- Swiss Paraplegic Research, Nottwil, Switzerland
- ICF Research Branch, Nottwil, Switzerland
| | | | | | | | | | - Gerold Stucki
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
- ICF Research Branch, Nottwil, Switzerland
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Jervis Rademeyer H, Gauthier C, Masani K, Pakosh M, Musselman KE. The effects of epidural stimulation on individuals living with spinal cord injury or disease: a scoping review. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.1962051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Hope Jervis Rademeyer
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- KITE, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Cindy Gauthier
- KITE, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Kei Masani
- KITE, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Maureen Pakosh
- Library and Information Services, University Health Network - Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Kristin E. Musselman
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- KITE, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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McHugh C, Taylor C, Mockler D, Fleming N. Epidural spinal cord stimulation for motor recovery in spinal cord injury: A systematic review. NeuroRehabilitation 2021; 49:1-22. [PMID: 33967072 DOI: 10.3233/nre-210093] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Epidural spinal cord stimulation (ESCS) emerged as a technology for eliciting motor function in the 1990's and was subsequently employed therapeutically in the population with spinal cord injury (SCI). Despite a considerable number of ESCS studies, a comprehensive systematic review of ESCS remains unpublished. OBJECTIVE The current review of the existing literature evaluated the efficacy of ESCS for improving motor function in individuals with SCI. METHODS A search for ESCS studies was performed using the following databases: Medline (Ovid), Web of Science and Embase. Furthermore, to maximize results, an inverse manual search of references cited by identified articles was also performed. Studies published between January 1995 and June 2020 were included. The search was constructed around the following key terms: Spinal cord stimulation, SCI and motor response generation. RESULTS A total of 3435 articles were initially screened, of which 18 met the inclusion criteria. The total sample comprised of 24 participants with SCI. All studies reported some measure of improvement in motor activity with ESCS, with 17 reporting altered EMG responses. Functional improvements were reported in stepping (n = 11) or muscle force (n = 4). Only 5 studies assessed ASIA scale pre- and post-intervention, documenting improved classification in 4 of 11 participants. Appraisal using the modified Downs and Black quality checklist determined that reviewed studies were of poor quality. Due to heterogeneity of outcome measures utilized in studies reviewed, a meta-analysis of data was not possible. CONCLUSION While the basic science is encouraging, the therapeutic efficacy of ESCS remains inconclusive.
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Affiliation(s)
- Conor McHugh
- Human Performance Laboratory, Department of Anatomy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Clare Taylor
- Human Performance Laboratory, Department of Anatomy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - David Mockler
- John Stearne Medical Library, Trinity Centre for Health Sciences, School of Medicine, St. James's Hospital, Dublin, Ireland
| | - Neil Fleming
- Human Performance Laboratory, Department of Anatomy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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The potential of prediction models of functioning remains to be fully exploited: A scoping review in the field of spinal cord injury rehabilitation. J Clin Epidemiol 2021; 139:177-190. [PMID: 34329726 DOI: 10.1016/j.jclinepi.2021.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/29/2021] [Accepted: 07/22/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The study aimed to explore existing prediction models of functioning in spinal cord injury (SCI). STUDY DESIGN AND SETTING The databases PubMed, EBSCOhost CINAHL Complete, and IEEE Xplore were searched for relevant literature. The search strategy included published search filters for prediction model and impact studies, index terms and keywords for SCI, and relevant outcome measures able to assess functioning as reflected in the International Classification of Functioning, Disability and Health (ICF). The search was completed in October 2020. RESULTS We identified seven prediction model studies reporting twelve prediction models of functioning. The identified prediction models were mainly envisioned to be used for rehabilitation planning, however, also other possible applications were stated. The method predominantly used was regression analysis and the investigated predictors covered mainly the ICF-components of body functions and activities and participation, next to characteristics of the health condition and health interventions. CONCLUSION Findings suggest that the development of prediction models of functioning for use in clinical practice remains to be fully exploited. By providing a comprehensive overview of what has been done, this review informs future research on prediction models of functioning in SCI and contributes to an efficient use of research evidence.
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Arsh A, Darain H, Ullah I, Shakil-ur-Rehman S. Diagnostic tests to assess balance in patients with spinal cord injury: a systematic review of their validity and reliability. ASIAN BIOMED 2021; 15:111-118. [PMID: 37551368 PMCID: PMC10388767 DOI: 10.2478/abm-2021-0014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Sophisticated biomechanical instruments can assess balance in patients with spinal cord injury (SCI) with accuracy and precision; however, they are costly and time consuming to use. Clinical diagnostic tests to assess balance in patients with SCI are less costly and easier to use, but there is limited literature available regarding their reliability and validity. Objectives To review systematically articles reporting the validity and reliability of diagnostic tests used to assess balance function in patients with SCI. Methods We searched for articles in the English language from the earliest record to December 15, 2020, which reported validity or reliability of any clinical instrument or diagnostic test used to assess balance in patients with SCI. Articles assessing balance in paraplegic patients with causes other than SCI were excluded. Databases included MEDLINE, AMED, EMBASE, HMIC, PsycINFO, CINAHL, Scopus, and Google Scholar. The COSMIN Risk of Bias checklist was used to assess the studies included and PRISMA-DTA guidelines were applied. Results We included 16 articles that assessed the validity or reliability of 10 diagnostic tests. The Functional Reach Test (FRT), Berg Balance Scale (BBS), and Mini-Balance Evaluation Systems Test (Mini-BESTest) were assessed by more than 1 study, while the remaining 7 diagnostic tests including the Function in Sitting Test, T-Shirt Test, Motor Assessment Scale item 3, Sitting Balance Score, 5 Times Sit-to-Stand Test, Tinetti scale, and Sitting Balance Measure were assessed by 1 study each. The FRT has good-to-excellent test-retest reliability, excellent inter-rater reliability, and good construct, concurrent, and convergent validity. The BBS has excellent inter-rater and intra-rater reliability, high internal consistency, and good concurrent and construct validity. The Mini-BESTest has excellent test-retest reliability, excellent inter-rater reliability, high internal consistency, and good concurrent, convergent, and construct validity. Conclusions The FRT, BBS, and Mini-BESTest appear to be valid and reliable clinical instruments to assess balance function in patients with SCI.
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Affiliation(s)
- Aatik Arsh
- Institute of Physical Medicine and Rehabilitation, Khyber Medical University, Peshawar, Khyber Pakhtunkhwa25100, Pakistan
| | - Haider Darain
- Institute of Physical Medicine and Rehabilitation, Khyber Medical University, Peshawar, Khyber Pakhtunkhwa25100, Pakistan
| | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar, Khyber Pakhtunkhwa25000, Pakistan
| | - Syed Shakil-ur-Rehman
- Riphah College of Rehabilitation and Allied Health Sciences, Riphah International University Lahore, Punjab54000, Pakistan
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Canavan C, Inoue T, McMahon S, Doody C, Blake C, Fullen BM. The Efficacy, Adverse Events & Withdrawal Rates of the Pharmacological Management of Chronic Spinal Cord Injury Pain: A Systematic Review & Meta-Analysis. PAIN MEDICINE 2021; 23:375-395. [PMID: 33844010 DOI: 10.1093/pm/pnab140] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To establish the efficacy of medications, incidence of adverse events (AE) and withdrawal rates (WR) of the pharmacological management of chronic spinal cord injury (SCI) pain. METHODOLOGY PubMed, MEDLINE, Embase, CINAHL, Web of Science, CENTRAL and PsycINFO were searched (November 2017) and updated (January 2020). Two independent review authors screened and identified papers for inclusion. RESULTS Twenty-one studies met inclusion for efficacy analysis and 17 for AEs and WR analysis; no additional paper were included from the up dated 2020 search. Treatments were divided into 6 categories: anticonvulsants (n = 6), antidepressants (n = 3), analgesics (n = 8), anti-spasticity (n = 2), cannabinoids (n = 1) and other (n = 2). Trials of anticonvulsants, antidepressants, and cannabinoids included long-term follow-up trials (2 weeks- 4 months), and analgesics, anti-spasticity, among others were short term trials (0-2 days). Effectiveness for NP was found for Pregabalin (3/3 studies) and Lidocaine (2/3 studies). Studies using Ketamine also reported effectiveness (2/2) but the quality of these papers was rated as poor. Most frequently reported AEs included dizziness, dry mouth, nausea and constipation. Pregabalin had a higher risk of somnolence (RR 3.15, 95% CI 2.00-4.98) and dizziness (RR 2.9, 95% CI 1.58-5.30). Ketamine had a higher risk of reduced vision (RR 9.00, 95% CI 0.05-146.11), dizziness (RR 8.33, 95% CI 1.73-40.10) and somnolence (RR 7.00, 95% CI 1.73-40.1). WRs ranged from: 18.4% (antidepressants), 0-30% (anticonvulsants), 0-10% (anti-spasticity), 0-48% (analgesics), 28.6% (cannabinoids) and 0-22.2% (other). CONCLUSION Pregabalin was found to be effective for NP versus placebo. Cannabinoids was ineffective for NP. AEs are a common cause for withdrawal. The nature of AEs was poorly reported and should be improved in future RCT's.
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Affiliation(s)
- Clare Canavan
- UCD Centre for Translational Pain Research, University College Dublin, Belfield Campus, Dublin, Ireland.,School of Public Health, Physiotherapy and Sports Science
| | - Takayoshi Inoue
- UCD Centre for Translational Pain Research, University College Dublin, Belfield Campus, Dublin, Ireland
| | - Sinead McMahon
- School of Public Health, Physiotherapy and Sports Science
| | - Catherine Doody
- UCD Centre for Translational Pain Research, University College Dublin, Belfield Campus, Dublin, Ireland.,School of Public Health, Physiotherapy and Sports Science
| | - Catherine Blake
- UCD Centre for Translational Pain Research, University College Dublin, Belfield Campus, Dublin, Ireland.,School of Public Health, Physiotherapy and Sports Science
| | - Brona M Fullen
- UCD Centre for Translational Pain Research, University College Dublin, Belfield Campus, Dublin, Ireland.,School of Public Health, Physiotherapy and Sports Science
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Powers MB, Pogue JR, Curcio NE, Patel S, Wierzchowski A, Thomas EV, Warren AM, Adams M, Turner E, Carl E, Froehlich-Grobe K, Sikka S, Foreman M, Leonard K, Douglas M, Bennett M, Driver S. Prolonged exposure therapy for PTSD among spinal cord injury survivors: Study protocol for a randomized controlled trial. Contemp Clin Trials Commun 2021; 22:100763. [PMID: 34013091 PMCID: PMC8113811 DOI: 10.1016/j.conctc.2021.100763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/28/2021] [Accepted: 03/26/2021] [Indexed: 10/28/2022] Open
Abstract
The National Spinal Cord Injury Statistical Center estimates 294,000 people in the US live with a spinal cord injury (SCI), with approximately 17,810 new cases each year. Although the physical outcomes associated with SCI have been widely studied, the psychological consequences of sustaining a SCI remain largely unexplored. Scant research has focused on posttraumatic stress disorder (PTSD) in this population, despite prevalence estimates suggesting that up to 60% of individuals with SCI experience PTSD post-injury, compared to only 7% of the general US population. Fortunately, prolonged exposure therapy (PE) is a well-researched and highly effective treatment for PTSD. However, no trauma focused exposure-based therapy for PTSD (e.g. PE) has not yet been tested in a SCI population. Thus, we aim to conduct the first test of an evidence-based intervention for PTSD among patients with SCI. Adults with SCI and PTSD (N = 60) will be randomly assigned to either: (1) 12-sessions of PE (2-3 sessions per week) or (2) a treatment as usual (TAU) control group who will receive the standard inpatient rehabilitation care for SCI patients. Primary outcomes will be assessed at 0, 6, 10, and 32 weeks.
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Affiliation(s)
- Mark B Powers
- Baylor University Medical Center, Dallas, TX, United States
| | - Jamie R Pogue
- Baylor University Medical Center, Dallas, TX, United States
| | | | - Sarita Patel
- Baylor University Medical Center, Dallas, TX, United States
| | | | | | | | - Maris Adams
- Baylor University Medical Center, Dallas, TX, United States
| | - Emma Turner
- Baylor University Medical Center, Dallas, TX, United States
| | - Emily Carl
- The University of Texas at Austin, Austin, TX, United States
| | | | - Seema Sikka
- Baylor Institute of Rehabilitation, Baylor Scott & White Health, Dallas, TX, United States
| | | | - Kiara Leonard
- Baylor University Medical Center, Dallas, TX, United States
| | - Megan Douglas
- Baylor Institute of Rehabilitation, Baylor Scott & White Health, Dallas, TX, United States
| | - Monica Bennett
- Baylor University Medical Center, Dallas, TX, United States
| | - Simon Driver
- Baylor Institute of Rehabilitation, Baylor Scott & White Health, Dallas, TX, United States
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Prang P, Schuld C, Rupp R, Hensel C, Weidner N. Influence of patient isolation due to colonization with multidrug-resistant organisms on functional recovery after spinal cord injury. PLoS One 2021; 16:e0249295. [PMID: 33770131 PMCID: PMC7997009 DOI: 10.1371/journal.pone.0249295] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 03/16/2021] [Indexed: 11/19/2022] Open
Abstract
STUDY DESIGN Chart reviews were combined with neurological and functional outcome data obtained from the prospective European Multicenter Study on Spinal Cord Injury (EMSCI, www.emsci.org). OBJECTIVES To determine if strict physical isolation of multidrug-resistant organisms (MDRO)-positive patients negatively affects neurological recovery and functional outcome in the first year after acute spinal cord injury (SCI). SETTING SCI Center Heidelberg University Hospital. METHODS Individuals with acute (< 6 weeks) traumatic or ischemic SCI were included. During primary comprehensive care, isolated MDRO-positive patients (n = 13) were compared with a MDRO-negative control group (n = 13) matched for functional (Spinal Cord Independence Measure-SCIM) and neurological impairment (motor scores based on the International Standards for Neurological Classification of Spinal Cord Injury-ISNCSCI) at an early stage up to 40 days after SCI. SCIM scores and motor scores were obtained at 12 weeks (intermediate stage) and 24 or 48 weeks (late stage) after SCI. RESULTS Isolated MDRO-positive (median duration of hospitalization: 175 days, 39% of inpatient stay under isolation measures) and non-isolated MDRO-negative (median duration of hospitalization: 161 days) patients showed functional and neurological improvements, which were not statistically different between groups at the intermediate and late stage. CONCLUSION Prolonged isolation due to MDRO colonization for over a third of the inpatient comprehensive care period does not appear to impair neurological recovery and functional outcome within the first year after SCI.
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Affiliation(s)
- Peter Prang
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Schuld
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Ruediger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Cornelia Hensel
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
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Santamaria AJ, Benavides FD, Saraiva PM, Anderson KD, Khan A, Levi AD, Dietrich WD, Guest JD. Neurophysiological Changes in the First Year After Cell Transplantation in Sub-acute Complete Paraplegia. Front Neurol 2021; 11:514181. [PMID: 33536992 PMCID: PMC7848788 DOI: 10.3389/fneur.2020.514181] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 11/05/2020] [Indexed: 12/15/2022] Open
Abstract
Neurophysiological testing can provide quantitative information about motor, sensory, and autonomic system connectivity following spinal cord injury (SCI). The clinical examination may be insufficiently sensitive and specific to reveal evolving changes in neural circuits after severe injury. Neurophysiologic data may provide otherwise imperceptible circuit information that has rarely been acquired in biologics clinical trials in SCI. We reported a Phase 1 study of autologous purified Schwann cell suspension transplantation into the injury epicenter of participants with complete subacute thoracic SCI, observing no clinical improvements. Here, we report longitudinal electrophysiological assessments conducted during the trial. Six participants underwent neurophysiology screening pre-transplantation with three post-transplantation neurophysiological assessments, focused on the thoracoabdominal region and lower limbs, including MEPs, SSEPs, voluntarily triggered EMG, and changes in GSR. We found several notable signals not detectable by clinical exam. In all six participants, thoracoabdominal motor connectivity was detected below the clinically assigned neurological level defined by sensory preservation. Additionally, small voluntary activations of leg and foot muscles or positive lower extremity MEPs were detected in all participants. Voluntary EMG was most sensitive to detect leg motor function. The recorded MEP amplitudes and latencies indicated a more caudal thoracic level above which amplitude recovery over time was observed. In contrast, further below, amplitudes showed less improvement, and latencies were increased. Intercostal spasms observed with EMG may also indicate this thoracic “motor level.” Galvanic skin testing revealed autonomic dysfunction in the hands above the injury levels. As an open-label study, we can establish no clear link between these observations and cell transplantation. This neurophysiological characterization may be of value to detect therapeutic effects in future controlled studies.
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Affiliation(s)
- Andrea J Santamaria
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, FL, United States
| | - Francisco D Benavides
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, FL, United States
| | - Pedro M Saraiva
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, FL, United States
| | - Kimberly D Anderson
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, FL, United States.,The Department of Neurological Surgery, Miller School of Medicine, The University of Miami, Miami, FL, United States
| | - Aisha Khan
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, FL, United States.,Miller School of Medicine, The Interdisciplinary Stem Cell Institute, The University of Miami, Miami, FL, United States
| | - Allan D Levi
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, FL, United States.,The Department of Neurological Surgery, Miller School of Medicine, The University of Miami, Miami, FL, United States
| | - W Dalton Dietrich
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, FL, United States.,The Department of Neurological Surgery, Miller School of Medicine, The University of Miami, Miami, FL, United States
| | - James D Guest
- The Miami Project to Cure Paralysis, Miller School of Medicine, The University of Miami, Miami, FL, United States.,The Department of Neurological Surgery, Miller School of Medicine, The University of Miami, Miami, FL, United States
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Rhee I, Do WS, Park KB, Park BK, Kim HW. Hip-Spine Syndrome in Patients With Spinal Cord Injuries: Hyperlordosis Associated With Severe Hip Flexion Contracture. Front Pediatr 2021; 9:646107. [PMID: 34322459 PMCID: PMC8310997 DOI: 10.3389/fped.2021.646107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 06/08/2021] [Indexed: 11/13/2022] Open
Abstract
Aim: Spinal cord injury (SCI)-related flaccid paralysis may result in a debilitating hyperlordosis associated with a progressive hip flexion contracture. The aim of this study was to evaluate the correction of hip flexion contractures and lumbar hyperlordosis in paraplegic patients that had a history of spinal cord injuries. Methods: A retrospective review was performed on 29 hips of 15 consecutive patients who underwent corrective surgeries for severe hip flexion deformity from 2006 to 2018. The mean age at surgery was 10.1 years (2.7 to 15.8), and the mean follow-up was 68 months (7 to 143). Relevant medical, surgical, and postoperative information was collected from the medical records and radiographs. Results: Improvements were seen in the mean hip flexion contracture (p < 0.001) with 100% hip correction at surgery and 92.1% at the latest follow-up. Mean lumbar lordosis decreased (p = 0.029) while the mean Cobb angle increased (p = 0.001) at the latest follow up. Functional score subdomains of the Spinal Cord Independence Measure, Functional Independence Measure, and modified Barthel activities of daily living (ADL) scores remained the same at the final follow-up. Conclusion: For paraplegic SCI patients, we found an association between treating the hip flexion contracture and indirect correction of their lumbar hyperlordosis. We recommend the surgeon carefully examine the hip pathology when managing SCI-related spinal deformities, especially increased lumbar lordosis.
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Affiliation(s)
- Isaac Rhee
- Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Woo Sung Do
- Division of Pediatric Orthopedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kun-Bo Park
- Division of Pediatric Orthopedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Byoung Kyu Park
- Department of Orthopedic Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Hyun Woo Kim
- Division of Pediatric Orthopedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
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SERBAN DE, DAIA CO, NEGOESCU CHEREGI I, CIOBANU V, ONOSE L, POPESCU C, ONOSE G. Topical Systematic and Synthetic Literature Review Regarding Men Sexual Dysfunctions after Spinal Cord Injury. BALNEO RESEARCH JOURNAL 2020. [DOI: 10.12680/balneo.2020.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Spinal cord injury (SCI) is a life-altering event usually associated with loss of motor and sensory, as well as with bladder, bowel and sexual, functions impairment. Recovering sexual function is one of the most important function tightly coupled with the life quality. In this respect, in the related literature can be found data regarding mainly: diagnosis/evaluation issues therapeutic/assistive-rehabilitative interventions (including connected to fertility troubles) and of psychological and or educational specific counseling, kind.
Materials and methods.This paper presents a current systematic (of Preferred Reporting Items for Systematic Reviews and Meta-Analyses – PRISMA – type) and synthetic literature review on sexual dysfunctions and respected available management options in male subjects with SCI, using the following search keywords/ combinations of key words: “men”, “sexual dysfunction”/ “fertility” / “erectile dysfunction”/ “ejaculatory problems” / “sexual disorder“, “spinal cord injury”, “paraplegia”/ ”tetraplegia” /“paraplegic”/ ”tetraplegic”, “management”/ “treatment”, by interrogating international renown data bases: NCBI/PubMed, NCBI/PMC, Elsevier, PEDro and respectively, ISI Web of Knowledge/Science – to check whether the selected articles are published in ISI indexed journals – considering publications from January 2009 to June 2019, written in English, open access articles and being “fair”/“high” quality on our PEDro inspired, customized quality classification of the selected papers – the basic criterion, being the weighted citations number per year.
Results. We have found initially 647 articles and eventually, after accomplishing the PRISMA stages (without meta-analysis), we have selected 16 articles matching all the above mentioned quest method’s requests (see further the figure representing our PRISMA type completed flow-diagram), covering (together with knowledge acquired from extra bibliographic resources, too).
Conclusions. Sexual disfunctions after SCI are complex and strongly add to the severe and multimodal disability the affected people – in the case of our work: men – experience. Therefore, they worth being fathomed and periodically reappraised.
Keywords: Spinal Cord injury (SCI), men sexual dysfunctions, systematic literature review, rehabilitation,
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Affiliation(s)
- Diana-Elena SERBAN
- Teaching Emergency Clinical Hospital “Bagdasar Arseni”, in Bucharest, Romania
| | - Cristina Octaviana DAIA
- Teaching Emergency Clinical Hospital “Bagdasar Arseni”, in Bucharest, Romania, University of Medicine and Pharmacy “Carol Davila”, in Bucharest, Romania
| | | | - Vlad CIOBANU
- Computer Science Department, Politehnica University of Bucharest, Bucharest, Romania
| | | | - Cristina POPESCU
- Teaching Emergency Clinical Hospital “Bagdasar Arseni”, in Bucharest, Romania
| | - Gelu ONOSE
- Teaching Emergency Clinical Hospital “Bagdasar Arseni”, in Bucharest, Romania, University of Medicine and Pharmacy “Carol Davila”, in Bucharest, Romania
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Tang W, Zhang X, Sun Y, Yao B, Chen X, Chen X, Gao X. Quantitative Assessment of Traumatic Upper-Limb Peripheral Nerve Injuries Using Surface Electromyography. Front Bioeng Biotechnol 2020; 8:795. [PMID: 32766224 PMCID: PMC7379167 DOI: 10.3389/fbioe.2020.00795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/22/2020] [Indexed: 11/13/2022] Open
Abstract
Background There is a great demand for convenient and quantitative assessment of upper-limb traumatic peripheral nerve injuries (PNIs) beyond their clinical routine. This would contribute to improved PNI management and rehabilitation. Objective The aim of this study was to develop a novel surface EMG examination method for quantitatively evaluating traumatic upper-limb PNIs. Methods Experiments were conducted to collect surface EMG data from forearm muscles on both sides of seven male subjects during their performance of eight designated hand and wrist motion tasks. All participants were clinically diagnosed as unilateral traumatic upper-limb PNIs on the ulnar nerve, median nerve, or radial nerve. Ten healthy control participants were also enrolled in the study. A novel framework consisting of two modules was also proposed for data analysis. One module was first used to identify whether a PNI occurs on a tested forearm using a machine learning algorithm by extracting and classifying features from surface EMG data. The second module was then used to quantitatively evaluate the degree of injury on three individual nerves on the examined arm. Results The evaluation scores yielded by the proposed method were highly consistent with the clinical assessment decisions for three nerves of all 34 examined arms (7 × 2 + 10 × 2), with a sensitivity of 81.82%, specificity of 98.90%, and significate linear correlation (p < 0.05) in quantitative decision points between the proposed method and the routine clinical approach. Conclusion This study offers a useful tool for PNI assessment and helps to promote extensive clinical applications of surface EMG.
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Affiliation(s)
- Weidi Tang
- School of Information Science and Technology, University of Science and Technology of China, Hefei, China
| | - Xu Zhang
- School of Information Science and Technology, University of Science and Technology of China, Hefei, China
| | - Yong Sun
- Institute of Criminal Sciences, Hefei Public Security Bureau, Hefei, China
| | - Bo Yao
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Xiang Chen
- School of Information Science and Technology, University of Science and Technology of China, Hefei, China
| | - Xun Chen
- School of Information Science and Technology, University of Science and Technology of China, Hefei, China
| | - Xiaoping Gao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Inoue T, Ichikawa D, Ueno T, Cheong M, Inoue T, Whetstone WD, Endo T, Nizuma K, Tominaga T. XGBoost, a Machine Learning Method, Predicts Neurological Recovery in Patients with Cervical Spinal Cord Injury. Neurotrauma Rep 2020; 1:8-16. [PMID: 34223526 PMCID: PMC8240917 DOI: 10.1089/neur.2020.0009] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The accurate prediction of neurological outcomes in patients with cervical spinal cord injury (SCI) is difficult because of heterogeneity in patient characteristics, treatment strategies, and radiographic findings. Although machine learning algorithms may increase the accuracy of outcome predictions in various fields, limited information is available on their efficacy in the management of SCI. We analyzed data from 165 patients with cervical SCI, and extracted important factors for predicting prognoses. Extreme gradient boosting (XGBoost) as a machine learning model was applied to assess the reliability of a machine learning algorithm to predict neurological outcomes compared with that of conventional methodology, such as a logistic regression or decision tree. We used regularly obtainable data as predictors, such as demographics, magnetic resonance variables, and treatment strategies. Predictive tools, including XGBoost, a logistic regression, and a decision tree, were applied to predict neurological improvements in the functional motor status (ASIA [American Spinal Injury Association] Impairment Scale [AIS] D and E) 6 months after injury. We evaluated predictive performance, including accuracy and the area under the receiver operating characteristic curve (AUC). Regarding predictions of neurological improvements in patients with cervical SCI, XGBoost had the highest accuracy (81.1%), followed by the logistic regression (80.6%) and the decision tree (78.8%). Regarding AUC, the logistic regression showed 0.877, followed by XGBoost (0.867) and the decision tree (0.753). XGBoost reliably predicted neurological alterations in patients with cervical SCI. The utilization of predictive machine learning algorithms may enhance personalized management choices through pre-treatment categorization of patients.
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Affiliation(s)
- Tomoo Inoue
- Department of Neurosurgery, National Health Organization Sendai Medical Center, Sendai, Miyagi, Japan
| | | | | | - Maxwell Cheong
- Department of Radiology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Takashi Inoue
- Department of Neurosurgery, National Health Organization Sendai Medical Center, Sendai, Miyagi, Japan
| | - William D. Whetstone
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Toshiki Endo
- Department of Neurosurgery, National Health Organization Sendai Medical Center, Sendai, Miyagi, Japan
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kuniyasu Nizuma
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Miyagi, Japan
- Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Cole S, Whiteneck G, Kilictepe S, Wang W, Hoback NG, Zhao H. Multi-stakeholder perspectives of environmental barriers to participation in travel-related activities after spinal cord injury. Disabil Rehabil 2020; 44:672-683. [DOI: 10.1080/09638288.2020.1774669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Shu Cole
- Indiana University, Bloomington, IN, USA
| | | | | | | | | | - Haoai Zhao
- Indiana University, Bloomington, IN, USA
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Comparing Activity and Participation between Acquired Brain Injury and Spinal-Cord Injury in Community-Dwelling People with Severe Disability Using WHODAS 2.0. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093031. [PMID: 32349383 PMCID: PMC7246687 DOI: 10.3390/ijerph17093031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 12/14/2022]
Abstract
Central-nervous-system (CNS) injuries constitute a significant cause of morbidity (often resulting in long-term disability) and mortality. This cross-sectional study compared the activity and participation of community-dwelling people with severe disability from acquired brain injuries (ABI) (n = 322) and spinal-cord injuries (SCI) (n = 183) to identify risk factors related to disability. Data were collected through a questionnaire survey of community-dwelling people with severe disability attending 65 healthcare centers. The survey included the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) and sociodemographic factors. We categorized a registered grade of disability of 1 or 2 as severe disability. WHODAS 2.0 domain and summary scores were compared between the ABI and SCI groups, and risk factors associated with disability were identified through regression analysis. ABI participants had significantly higher disability in cognition and relationships, whereas patients with SCI had higher disability in mobility (p < 0.05). Onset duration was negatively correlated with cognition, relationships, participation, and summary scores in ABI participants (p < 0.05). Neither group’s socioeconomic factors were associated with WHODA 2.0 scores. Understanding the different patterns of disability between SCI and ABI in community-dwelling people with severe disability helps establish future plans for the management of health resources.
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Effectiveness of anodal transcranial direct current stimulation to improve muscle strength and motor functionality after incomplete spinal cord injury: a systematic review and meta-analysis. Spinal Cord 2020; 58:635-646. [DOI: 10.1038/s41393-020-0438-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 02/02/2020] [Accepted: 02/04/2020] [Indexed: 01/04/2023]
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40
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Dombovy-Johnson ML, Hunt CL, Morrow MM, Lamer TJ, Pittelkow TP. Current Evidence Lacking to Guide Clinical Practice for Spinal Cord Stimulation in the Treatment of Neuropathic Pain in Spinal Cord Injury: A Review of the Literature and a Proposal for Future Study. Pain Pract 2020; 20:325-335. [PMID: 31691496 DOI: 10.1111/papr.12855] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/25/2019] [Accepted: 10/31/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND/OBJECTIVE Chronic pain is commonly reported in individuals with spinal cord injuries (SCIs), with recent prevalence reported as high as 80%. Uncontrolled pain is known to decrease quality of life, attenuate mood, and impact sleep. Spinal cord stimulation (SCS) for the treatment of refractory pain was first used in the SCI population in 1972. To date there have been no randomized controlled trials examining the effect of SCS on neuropathic pain post-SCI. A literature review in 2009 identified 27 studies, the majority prior to 2000, that included at least 1 patient with SCI. Given the significant advancements in the field of SCS, this review examines the updated evidence of SCS for the treatment of neuropathic pain in individuals with SCI and provides guidance on future investigations. METHODS MEDLINE and EMBASE databases were searched. All published reports, case series, and clinical trials reviewing SCS for neuropathic pain that included at least 1 individual with SCI were included. RESULTS The initial search identified 376 reports, of which 22 met inclusion criteria, for a total of 69 patients. All reports were of very low quality. A majority of the reported patients were male, underwent tonic stimulation, and reportedly experienced improvement in pain and spasticity, with decreased use of pain medication. CONCLUSIONS The synthesized findings from primarily case studies support the safety of SCS in SCI with the suggestion of potential pain relief benefit; however, data from low-quality studies are insufficient for informing clinical practice. A well-designed, prospective clinical trial is proposed to further investigate this indication.
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Affiliation(s)
| | - Christine L Hunt
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Melissa M Morrow
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Tim J Lamer
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Thomas P Pittelkow
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
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Shanmuganathan K, Zhuo J, Bodanapally UK, Kuladeep S, Aarabi B, Adams J, Miller C, Gullapallie RP, Menakar J. Comparison of Acute Diffusion Tensor Imaging and Conventional Magnetic Resonance Parameters in Predicting Long-Term Outcome after Blunt Cervical Spinal Cord Injury. J Neurotrauma 2020; 37:458-465. [DOI: 10.1089/neu.2019.6394] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
| | - Jiachen Zhuo
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Uttam K. Bodanapally
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sudini Kuladeep
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Bizhan Aarabi
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jason Adams
- Department of Rehabilitation Services, University of Maryland School of Medicine, Baltimore, Maryland
| | - Catriona Miller
- Aeromedical Research Department, U.S. Air Force School of Aerospace Medicine, Center for the Sustainment of Trauma and Readiness Skills, Baltimore, Maryland
| | - Rao P. Gullapallie
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jay Menakar
- R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
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Validation and application of the International Classification of Functioning core set for spinal cord injury in the Turkish patients. Turk J Phys Med Rehabil 2019; 65:244-258. [PMID: 31663073 DOI: 10.5606/tftrd.2019.3045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 09/02/2018] [Indexed: 11/21/2022] Open
Abstract
Objectives The aim of this study was to apply the Comprehensive International Classification of Functioning, Disability and Health (ICF)- Core Set for spinal cord injury (SCI) -early post-acute-situation in the Turkish SCI patients and to investigate its construct validity. Patients and methods One-hundred and twenty patients with SCI were included in this prospective and descriptive study. ICF data were primarily collected by conducting interviews with patients as well as from their acute medical management records, physical examination findings and laboratory measurements. The percentage of participants and the frequency of the problems encountered at each level of ICF category were reported. Furthermore, the construct validity was evaluated by calculating the Spearman correlation between the ICF categories and other generic and disease specific measures. Results The study illustrated that 55 of the 63 ICF categories of the Component Body Functions (CBF) and each and every category for the Component Body Structures (CBS) as well as the Component Activities and Participation (CAP) were reported as a problem among the Turkish patients with SCI. Furthermore, 24 ICF categories for the Component Environmental Factors (CEF) were determined as a facilitator while 6 ICF categories were identified as a barrier. The ICF-Core Set for SCI illustrated a high construct validity with some of the generic and disease-specific measures. Conclusion Our results identified the common problems, complications and special needs in a Turkish population with SCI. We suggest that the application of ICF-Core Set in our patients provided us with a unique capability to assess their every aspect of disability, health and functioning.
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Tomaschek R, Gemperli A, Rupp R, Geng V, Scheel-Sailer A. A systematic review of outcome measures in initial rehabilitation of individuals with newly acquired spinal cord injury: providing evidence for clinical practice guidelines. Eur J Phys Rehabil Med 2019; 55:605-617. [DOI: 10.23736/s1973-9087.19.05676-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Stampas A, Dominick E, Zhu L. Evaluation of functional outcomes in traumatic spinal cord injury with rehabilitation-acquired urinary tract infections: A retrospective study. J Spinal Cord Med 2019; 42:579-585. [PMID: 29611464 PMCID: PMC6758698 DOI: 10.1080/10790268.2018.1452389] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the impact of urinary tract infections (UTIs) acquired during acute inpatient traumatic Spinal Cord Injury (tSCI) rehabilitation on Functional Independence Measure (FIM) gains. DESIGN Retrospective chart review of consecutive patients with tSCI admitted to an acute rehabilitation facility from 2007-2012. The primary outcome was FIM scores and the association with UTI. RESULTS The sample included 110 patients and 70 acquired UTIs. No demographic differences were observed between groups with and without UTI. Those with UTIs had significantly lower FIM motor scores, on admission, discharge, and gain, as well as lower FIM efficiency and longer lengths of stay compared to those without a UTI. Recurrence of UTI was associated with increased length of stay, but did not impact FIM motor gains. CONCLUSIONS There was a statistically significant correlation between acquired UTIs and lower FIM motor scores on admission, gain, and discharge in tSCI rehabilitation. The correlation of UTI and decreased FIM gains are similar to other neurorehabilitation populations with UTI occurrence. UTIs are an important negative variable when measuring functional outcomes in rehabilitation. Further prospective studies should be performed to investigate this correlation.
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Affiliation(s)
- Argyrios Stampas
- Department of PM&R University of Texas Health Science Center at Houston, TIRR Memorial Hermann, Houston, Texas, USA,Correspondence to: Argy Stampas, MD, TIRR Memorial Hermann, 1333 Moursund St., Rm 165.6D, Houston, Texas 77030, USA.
| | | | - Liang Zhu
- Center for Clinical and Translational Sciences, University of Texas Health Science Center at Houston, Houston, Texas, USA
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Pavese C, Bachmann LM, Schubert M, Curt A, Mehnert U, Schneider MP, Scivoletto G, Finazzi Agrò E, Maier D, Abel R, Weidner N, Rupp R, Kessels AG, Kessler TM. Bowel Outcome Prediction After Traumatic Spinal Cord Injury: Longitudinal Cohort Study. Neurorehabil Neural Repair 2019; 33:902-910. [DOI: 10.1177/1545968319868722] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background. Predicting functional outcomes after traumatic spinal cord injury (SCI) is essential for counseling, rehabilitation planning, and discharge. Moreover, the outcome prognosis is crucial for patient stratification when designing clinical trials. However, no valid prediction rule is currently available for bowel outcomes after a SCI. Objective. To generate a model for predicting the achievement of independent, reliable bowel management at 1 year after traumatic SCI. Methods. We performed multivariable logistic regression analyses of data for 1250 patients with traumatic SCIs that were included in the European Multicenter Study about Spinal Cord Injury. The resulting model was prospectively validated on data for 186 patients. As potential predictors, we evaluated age, sex, and variables from the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and the Spinal Cord Independence Measure (SCIM), measured within 40 days of the injury. A positive outcome at 1 year post-SCI was assessed with item 7 of the SCIM. Results. The model relied on a single predictor, the ISNCSCI total motor score—that is, the sum of muscle strengths in 5 key muscle groups in each limb. The area under the receiver operating characteristics curve (aROC) was 0.837 (95% CI: 0.815-0.859). The prospective validation confirmed high predictive power: aROC = 0.817 (95% CI: 0.754-0.881). Conclusions. We generated a valid model for predicting independent, reliable bowel management at 1 year after traumatic SCI. Its application could improve counseling, optimize patient-tailored rehabilitation planning, and become crucial for appropriate patient stratification in future clinical trials.
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Affiliation(s)
- Chiara Pavese
- Balgrist University Hospital, University of Zürich, Zürich, Switzerland
- University of Pavia, Pavia, Italy; Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | | | - Martin Schubert
- Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Armin Curt
- Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Ulrich Mehnert
- Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Marc P. Schneider
- Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | | | | | | | | | | | - Rüdiger Rupp
- Heidelberg University Hospital, Heidelberg, Germany
| | | | - Thomas M. Kessler
- Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Yeung HY, Iyer P, Pryor J, Nicholson M. Dietary management of neurogenic bowel in adults with spinal cord injury: an integrative review of literature. Disabil Rehabil 2019; 43:1208-1219. [PMID: 31415185 DOI: 10.1080/09638288.2019.1652702] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine the literature for current evidence on the dietary management of neurogenic bowel in adults with spinal cord injuries (SCIs). BACKGROUND Neurogenic bowel dysfunction presenting as faecal incontinence or constipation is a common occurrence in individuals with SCI. It poses numerous challenges for the management of bowel function and has a significant impact on quality of life following SCI. Dietary management is a common, early treatment strategy as a conservative approach for neurogenic bowel; however, current recommendations rely on expert opinion only. METHODS An integrative review of the literature using a systematic search was conducted using Medline, Embase, CINAHL, Proquest, and Google Scholar. The selected articles were critically appraised using Critical Appraisal Skills Programme checklists by two independent reviewers. The risk of bias of studies and the quality of evidence for outcomes were assessed using the risk of bias tool and the grading of recommendations, assessment, development, and evaluation system in the Cochrane handbook for systematic review of interventions. RESULTS Thirteen studies that met the inclusion criteria were identified exploring a variety of diet-related factors: foods, dietary behaviours, and multiple interventions including a diet plan. However, the dietary management strategies used varied significantly between studies, posing challenges to ascertain its efficacy. CONCLUSION Given the low level of evidence and paucity of data on dietary management of neurogenic bowel, the efficacy of dietary strategies (alone or in combination with others) in managing neurogenic bowel cannot be substantiated from the studies identified. Therefore, more robust studies are warranted to bridge this gap.IMPLICATIONS FOR REHABILITATIONConsumption of ∼15 g dietary fibre is shown to be beneficial in managing neurogenic bowel in SCI.Further research is required to strengthen evidence for fibre recommendations and investigating the potential benefits of traditional and non-traditional dietary approaches.
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Affiliation(s)
- Hiu Yan Yeung
- Nutrition and Dietetics, University of Sydney, Sydney, Australia
| | - Priya Iyer
- Nutrition and Dietetics, Royal Rehab Centre Sydney, Sydney, Australia
| | - Julie Pryor
- Nursing Research and Development, Royal Rehab Centre Sydney, Sydney, Australia
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Application of electrophysiological measures in spinal cord injury clinical trials: a narrative review. Spinal Cord 2019; 57:909-923. [PMID: 31337870 DOI: 10.1038/s41393-019-0331-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 01/05/2023]
Abstract
STUDY DESIGN Narrative review. OBJECTIVES To discuss how electrophysiology may contribute to future clinical trials in spinal cord injury (SCI) in terms of: (1) improvement of SCI diagnosis, patient stratification and determination of exclusion criteria; (2) the assessment of adverse events; and (3) detection of therapeutic effects following an intervention. METHODS An international expert panel for electrophysiological measures in SCI searched and discussed the literature focused on the topic. RESULTS Electrophysiology represents a valid method to detect, track, and quantify readouts of nerve functions including signal conduction, e.g., evoked potentials testing long spinal tracts, and neural processing, e.g., reflex testing. Furthermore, electrophysiological measures can predict functional outcomes and thereby guide rehabilitation programs and therapeutic interventions for clinical studies. CONCLUSION Objective and quantitative measures of sensory, motor, and autonomic function based on electrophysiological techniques are promising tools to inform and improve future SCI trials. Complementing clinical outcome measures, electrophysiological recordings can improve the SCI diagnosis and patient stratification, as well as the detection of both beneficial and adverse events. Specifically composed electrophysiological measures can be used to characterize the topography and completeness of SCI and reveal neuronal integrity below the lesion, a prerequisite for the success of any interventional trial. Further validation of electrophysiological tools with regard to their validity, reliability, and sensitivity are needed in order to become routinely applied in clinical SCI trials.
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Liu N, Xing H, Zhou M, Biering-Sørensen F. Lack of knowledge and training are the major obstacles in application of the Spinal Cord Independence Measure (SCIM) in China. J Spinal Cord Med 2019; 42:437-443. [PMID: 29595400 PMCID: PMC6718138 DOI: 10.1080/10790268.2018.1454021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE To investigate the use of functional outcome measurements after spinal cord injury (SCI) in current clinical practice and to explore the knowledge about the Spinal Cord Independence Measure (SCIM) among SCI physicians in China, and to find facilitators for a broader utilization of SCIM. DESIGN A survey-based study. SETTING SCI workshops at Peking University. PARTICIPANTS 125 Chinese SCI physicians attending annual workshops in two consecutive years. INTERVENTIONS Not applicable. OUTCOME MEASURES A questionnaire was administered. The following items were included: whether functional outcome measurement for SCI individuals was performed and with which assessment tool(s); what items should be included in the assessment; whether they knew about the SCIM, its latest version, the Chinese translation, and if so from what source; the possible reasons why SCIM was not implemented in clinical practice; and whether training before using the SCIM was needed, and the training method preferred. RESULTS Among these physicians, 84.8% performed functional outcome measurement for individuals with SCI, but only 29.6% of attendees were aware of the SCIM and 20.8% had used it. Lack of training was the major reason why SCIM was not used in clinical practice. Furthermore, 74.4% of the physicians felt they needed formal training before using the SCIM. CONCLUSION The use of SCIM is limited in clinical practice in China, which is mainly attributed to lack of knowledge and training. Formal training on the use of the SCIM is essential for its dissemination and will improve functional SCI outcome measurement in China.
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Affiliation(s)
- Nan Liu
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Huayi Xing
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Mouwang Zhou
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China,Correspondence to: Professor Mouwang Zhou, Department of Rehabilitation Medicine, Peking UniversityThird Hospital, No. 49 North Garden Road, Beijing, China, 100191; Ph: +86 (10) 8226-6688, Fax: +86 (10) 8226-5861.
| | - Fin Biering-Sørensen
- Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Burridge J, Alt Murphy M, Buurke J, Feys P, Keller T, Klamroth-Marganska V, Lamers I, McNicholas L, Prange G, Tarkka I, Timmermans A, Hughes AM. A Systematic Review of International Clinical Guidelines for Rehabilitation of People With Neurological Conditions: What Recommendations Are Made for Upper Limb Assessment? Front Neurol 2019; 10:567. [PMID: 31293493 PMCID: PMC6603199 DOI: 10.3389/fneur.2019.00567] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/13/2019] [Indexed: 11/27/2022] Open
Abstract
Background: Upper limb impairment is a common problem for people with neurological disabilities, affecting activity, performance, quality of life, and independence. Accurate, timely assessments are required for effective rehabilitation, and development of novel interventions. International consensus on upper limb assessment is needed to make research findings more meaningful, provide a benchmark for quality in clinical practice, more cost-effective neurorehabilitation and improved outcomes for neurological patients undergoing rehabilitation. Aim: To conduct a systematic review, as part of the output of a European COST Action, to identify what recommendations are made for upper limb assessment. Methods: We systematically reviewed published guidance on measures and protocols for assessment of upper limb function in neurological rehabilitation via electronic databases from January 2007–December 2017. Additional records were then identified through other sources. Records were selected for inclusion based on scanning of titles, abstracts and full text by two authors working independently, and a third author if there was disagreement. Records were included if they referred to “rehabilitation” and “assessment” or “measurement”. Reasons for exclusion were documented. Results: From the initial 552 records identified (after duplicates were removed), 34 satisfied our criteria for inclusion, and only six recommended specific outcome measures and /or protocols. Records were divided into National Guidelines and other practice guidelines published in peer reviewed Journals. There was agreement that assessment is critical, should be conducted early and at regular intervals and that there is a need for standardized measures. Assessments should be conducted by a healthcare professional trained in using the measure and should encompass body function and structure, activity and participation. Conclusions: We present a comprehensive, critical, and original summary of current recommendations. Defining a core set of measures and agreed protocols requires international consensus between experts representing the diverse and multi-disciplinary field of neurorehabilitation including clinical researchers and practitioners, rehabilitation technology researchers, and commercial developers. Current lack of guidance may hold-back progress in understanding function and recovery. Together with a Delphi consensus study and an overview of systematic reviews of outcome measures it will contribute to the development of international guidelines for upper limb assessment in neurological conditions.
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Affiliation(s)
- Jane Burridge
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Margit Alt Murphy
- Institute of Neuroscience and Physiology, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jaap Buurke
- Roessingh Research and Development, Enschede, Netherlands.,Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, Netherlands
| | - Peter Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | | | | | - Ilse Lamers
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Lauren McNicholas
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Gerdienke Prange
- Roessingh Research and Development, Enschede, Netherlands.,Faculty of Engineering Technology, University of Twente, Enschede, Netherlands
| | - Ina Tarkka
- Faculty of Sport and Health Sciences, University of Jyväskylá, Jyväskylä, Finland
| | - Annick Timmermans
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Ann-Marie Hughes
- Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
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Tarvonen-Schröder S, Kaljonen A, Laimi K. Comparing functioning in spinal cord injury and in chronic spinal pain with two ICF-based instruments: WHODAS 2.0 and the WHO minimal generic data set covering functioning and health. Clin Rehabil 2019; 33:1241-1251. [PMID: 30935211 DOI: 10.1177/0269215519839104] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate whether the two briefest validated ICF-based (International Classification of Functioning, Disability and Health) tools can detect differences between different spinal conditions. DESIGN Cross-sectional study. SETTING University hospital rehabilitation clinic. SUBJECTS A total of 84 patients with spinal cord injury and 81 with chronic spinal pain. MAIN MEASURES Disability evaluated using self-reported and proxy 12-item WHODAS 2.0 ((World Health Organization Disability Assessment Schedule), and physician-rated WHO minimal generic data set covering functioning and health. FINDINGS The two measures used showed severe disability in both patient populations, those with spinal cord injury (mean age 47.5 years, SD 13.2) and those with chronic spinal pain (mean age 47.2 years, SD 9.5), WHODAS patient sum being 18.4 (SD 9.6) versus 22.0 (SD 9.0), P < 0.05, and the WHO generic data set 15.6 (SD 4.4) versus 14.2 (SD 3.7), P < 0.01, respectively. Correlations between patient and proxy ratings and between the two disability scales were mostly strong. Severe restrictions were found in the working ability of both the populations, in mobility of patients with spinal cord injury and in pain function of patients with chronic spinal pain. In this tertiary clinic patient population, patients with spinal pain perceived more problems in emotional and cognitive functions, and in participation than patients with spinal cord injury. CONCLUSIONS Both scales were able to find differences between two patient populations with severe disability.
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Affiliation(s)
- Sinikka Tarvonen-Schröder
- 1 Department of Rehabilitation and Brain Trauma, Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | - Anne Kaljonen
- 2 Department of Biostatistics, University of Turku, Turku, Finland
| | - Katri Laimi
- 3 Department of Physical and Rehabilitation Medicine, Turku University Hospital and University of Turku, Turku, Finland
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