1
|
Alashram AR. Letter to the Editor on "Effects of Anodal Transcranial Direct Current Stimulation With Overground Gait Training on Lower Limb Performance in Individuals With Incomplete Spinal Cord Injury". Arch Phys Med Rehabil 2024; 105:1408-1409. [PMID: 38554794 DOI: 10.1016/j.apmr.2024.02.738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 02/06/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Anas R Alashram
- Physiotherapy Department, Middle East University, Amman, Jordan; Applied Science Research Center, Applied Science Private University, Amman, Jordan; Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy.
| |
Collapse
|
2
|
Tajali S, Balbinot G, Pakosh M, Sayenko DG, Zariffa J, Masani K. Modulations in neural pathways excitability post transcutaneous spinal cord stimulation among individuals with spinal cord injury: a systematic review. Front Neurosci 2024; 18:1372222. [PMID: 38591069 PMCID: PMC11000807 DOI: 10.3389/fnins.2024.1372222] [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: 01/17/2024] [Accepted: 03/06/2024] [Indexed: 04/10/2024] Open
Abstract
Introduction Transcutaneous spinal cord stimulation (TSCS), a non-invasive form of spinal cord stimulation, has been shown to improve motor function in individuals living with spinal cord injury (SCI). However, the effects of different types of TSCS currents including direct current (DC-TSCS), alternating current (AC-TSCS), and spinal paired stimulation on the excitability of neural pathways have not been systematically investigated. The objective of this systematic review was to determine the effects of TSCS on the excitability of neural pathways in adults with non-progressive SCI at any level. Methods The following databases were searched from their inception until June 2022: MEDLINE ALL, Embase, Web of Science, Cochrane Library, and clinical trials. A total of 4,431 abstracts were screened, and 23 articles were included. Results Nineteen studies used TSCS at the thoracolumbar enlargement for lower limb rehabilitation (gait & balance) and four studies used cervical TSCS for upper limb rehabilitation. Sixteen studies measured spinal excitability by reporting different outcomes including Hoffmann reflex (H-reflex), flexion reflex excitability, spinal motor evoked potentials (SMEPs), cervicomedullay evoked potentials (CMEPs), and cutaneous-input-evoked muscle response. Seven studies measured corticospinal excitability using motor evoked potentials (MEPs) induced by transcranial magnetic stimulation (TMS), and one study measured somatosensory evoked potentials (SSEPs) following TSCS. Our findings indicated a decrease in the amplitude of H-reflex and long latency flexion reflex following AC-TSCS, alongside an increase in the amplitudes of SMEPs and CMEPs. Moreover, the application of the TSCS-TMS paired associative technique resulted in spinal reflex inhibition, manifested by reduced amplitudes in both the H-reflex and flexion reflex arc. In terms of corticospinal excitability, findings from 5 studies demonstrated an increase in the amplitude of MEPs linked to lower limb muscles following DC-TSCS, in addition to paired associative stimulation involving repetitive TMS on the brain and DC-TSCS on the spine. There was an observed improvement in the latency of SSEPs in a single study. Notably, the overall quality of evidence, assessed by the modified Downs and Black Quality assessment, was deemed poor. Discussion This review unveils the systematic evidence supporting the potential of TSCS in reshaping both spinal and supraspinal neuronal circuitries post-SCI. Yet, it underscores the critical necessity for more rigorous, high-quality investigations.
Collapse
Affiliation(s)
- Shirin Tajali
- KITE Research Institute – University Health Network, Toronto, ON, Canada
| | - Gustavo Balbinot
- KITE Research Institute – University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Center for Advancing Neurotechnological Innovation to Application – CRANIA, University Health Network, Toronto, ON, Canada
| | - Maureen Pakosh
- Library & Information Services, University Health Network, Toronto Rehabilitation Institute, ON, Canada
| | - Dimitry G. Sayenko
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, United States
| | - Jose Zariffa
- KITE Research Institute – University Health Network, Toronto, ON, Canada
- Edward S. Rogers Sr. Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Kei Masani
- KITE Research Institute – University Health Network, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
3
|
Teasell R, Flores-Sandoval C, Bateman EA, MacKenzie HM, Sequeira K, Bayley M, Janzen S. Overview of randomized controlled trials of moderate to severe traumatic brain injury: A systematic review. NeuroRehabilitation 2024; 54:509-520. [PMID: 38669488 DOI: 10.3233/nre-240019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
BACKGROUND Given the complexity of post-TBI medical, surgical, and rehabilitative care, research is critical to optimize interventions across the continuum of care and improve outcomes for persons with moderate to severe TBI. OBJECTIVE To characterize randomized controlled trials (RCTs) of moderate to severe traumatic brain injury (TBI) in the literature. METHOD Systematic searches of MEDLINE, PubMed, Scopus, CINAHL, EMBASE and PsycINFO for RCTs up to December 2022 inclusive were conducted in accordance with PRISMA guidelines. RESULTS 662 RCTs of 91,946 participants published from 1978 to 2022 met inclusion criteria. The number of RCTs published annually has increased steadily. The most reported indicator of TBI severity was the Glasgow Coma Scale (545 RCTs, 82.3%). 432 (65.3%) RCTs focused on medical/surgical interventions while 230 (34.7%) addressed rehabilitation. Medical/surgical RCTs had larger sample sizes compared to rehabilitation RCTs. Rehabilitation RCTs accounted for only one third of moderate to severe TBI RCTs and were primarily conducted in the chronic phase post-injury relying on smaller sample sizes. CONCLUSION Further research in the subacute and chronic phases as well as increasing rehabilitation focused TBI RCTs will be important to optimizing the long-term outcomes and quality of life for persons living with TBI.
Collapse
Affiliation(s)
- Robert Teasell
- Parkwood Institute Research, Lawson Research Institute, London, ON, Canada
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Parkwood Institute, St. Joseph's Health Care London, London, ON, Canada
| | | | - Emma A Bateman
- Parkwood Institute Research, Lawson Research Institute, London, ON, Canada
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Parkwood Institute, St. Joseph's Health Care London, London, ON, Canada
| | - Heather M MacKenzie
- Parkwood Institute Research, Lawson Research Institute, London, ON, Canada
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Parkwood Institute, St. Joseph's Health Care London, London, ON, Canada
| | - Keith Sequeira
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Parkwood Institute, St. Joseph's Health Care London, London, ON, Canada
| | - Mark Bayley
- Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- KITE Research Institute, University Health Network, Toronto, ON, Canada
- University Health Network, Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Shannon Janzen
- Parkwood Institute Research, Lawson Research Institute, London, ON, Canada
| |
Collapse
|
4
|
Fallah N, Noonan VK, Waheed Z, Charest-Morin R, Dandurand C, Cheng C, Ailon T, Dea N, Paquette S, Street JT, Fisher C, Dvorak MF, Kwon BK. Pattern of neurological recovery in persons with an acute cervical spinal cord injury over the first 14 days post injury. Front Neurol 2023; 14:1278826. [PMID: 38169683 PMCID: PMC10758406 DOI: 10.3389/fneur.2023.1278826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/31/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction Following a traumatic spinal cord injury (SCI) it is critical to document the level and severity of injury. Neurological recovery occurs dynamically after injury and a baseline neurological exam offers a snapshot of the patient's impairment at that time. Understanding when this exam occurs in the recovery process is crucial for discussing prognosis and acute clinical trial enrollment. The objectives of this study were to: (1) describe the trajectory of motor recovery in persons with acute cervical SCI in the first 14 days post-injury; and (2) evaluate if the timing of the baseline neurological assessment in the first 14 days impacts the amount of motor recovery observed. Methods Data were obtained from the Rick Hansen Spinal Cord Injury Registry (RHSCIR) site in Vancouver and additional neurological data was extracted from medical charts. Participants with a cervical injury (C1-T1) who had a minimum of three exams (including a baseline and discharge exam) were included. Data on the upper-extremity motor score (UEMS), total motor score (TMS) and American Spinal Injury Association (ASIA) Impairment Scale (AIS) were included. A linear mixed-effect model with additional variables (AIS, level of injury, UEMS, time, time2, and TMS) was used to explore the pattern and amount of motor recovery over time. Results Trajectories of motor recovery in the first 14 days post-injury showed significant improvements in both TMS and UEMS for participants with AIS B, C, and D injuries, but was not different for high (C1-4) vs. low (C5-T1) cervical injuries or AIS A injuries. The timing of the baseline neurological examination significantly impacted the amount of motor recovery in participants with AIS B, C, and D injuries. Discussion Timing of baseline neurological exams was significantly associated with the amount of motor recovery in cervical AIS B, C, and D injuries. Studies examining changes in neurological recovery should consider stratifying by severity and timing of the baseline exam to reduce bias amongst study cohorts. Future studies should validate these estimates for cervical AIS B, C, and D injuries to see if they can serve as an "adjustment factor" to control for differences in the timing of the baseline neurological exam.
Collapse
Affiliation(s)
- Nader Fallah
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Zeina Waheed
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
| | - Raphaele Charest-Morin
- Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia, Vancouver, BC, Canada
| | - Charlotte Dandurand
- Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia, Vancouver, BC, Canada
| | | | - Tamir Ailon
- Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia, Vancouver, BC, Canada
| | - Nicolas Dea
- Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia, Vancouver, BC, Canada
| | - Scott Paquette
- Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia, Vancouver, BC, Canada
| | - John T. Street
- Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia, Vancouver, BC, Canada
| | - Charles Fisher
- Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia, Vancouver, BC, Canada
| | - Marcel F. Dvorak
- Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Brian K. Kwon
- Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
5
|
Pelletier C. Exercise prescription for persons with spinal cord injury: a review of physiological considerations and evidence-based guidelines. Appl Physiol Nutr Metab 2023; 48:882-895. [PMID: 37816259 DOI: 10.1139/apnm-2023-0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
Persons with spinal cord injury (SCI) experience gains in fitness, physical and mental health from regular participation in exercise and physical activity. Due to changes in physiological function of the cardiovascular, nervous, and muscular systems, general population physical activity guidelines and traditional exercise prescription methods are not appropriate for the SCI population. Exercise guidelines specific to persons with SCI recommend progressive training beginning at 20 min of moderate to vigorous intensity aerobic exercise twice per week transitioning to 30 min three times per week, with strength training of the major muscle groups two times per week. These population-specific guidelines were designed considering the substantial barriers to physical activity for persons with SCI and can be used to frame an individual exercise prescription. Rating of perceived exertion (i.e., perceptually regulated exercise) is a practical way to indicate moderate to vigorous intensity exercise in community settings. Adapted exercise modes include arm cycle ergometry, hybrid arm-leg cycling, and recumbent elliptical equipment. Body weight-supported treadmill training and other rehabilitation modalities may improve some aspects of health and fitness for people with SCI if completed at sufficient intensity. Disability-specific community programs offer beneficial opportunities for persons with SCI to experience quality exercise opportunities but are not universally available.
Collapse
Affiliation(s)
- Chelsea Pelletier
- School of Health Sciences, Faculty of Human and Health Sciences, University of Northern British Columbia, Prince George, BC, Canada
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
6
|
Hodgkiss DD, Bhangu GS, Lunny C, Jutzeler CR, Chiou SY, Walter M, Lucas SJE, Krassioukov AV, Nightingale TE. Exercise and aerobic capacity in individuals with spinal cord injury: A systematic review with meta-analysis and meta-regression. PLoS Med 2023; 20:e1004082. [PMID: 38011304 PMCID: PMC10712898 DOI: 10.1371/journal.pmed.1004082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/11/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND A low level of cardiorespiratory fitness [CRF; defined as peak oxygen uptake ([Formula: see text]O2peak) or peak power output (PPO)] is a widely reported consequence of spinal cord injury (SCI) and a major risk factor associated with chronic disease. However, CRF can be modified by exercise. This systematic review with meta-analysis and meta-regression aimed to assess whether certain SCI characteristics and/or specific exercise considerations are moderators of changes in CRF. METHODS AND FINDINGS Databases (MEDLINE, EMBASE, CENTRAL, and Web of Science) were searched from inception to March 2023. A primary meta-analysis was conducted including randomised controlled trials (RCTs; exercise interventions lasting >2 weeks relative to control groups). A secondary meta-analysis pooled independent exercise interventions >2 weeks from longitudinal pre-post and RCT studies to explore whether subgroup differences in injury characteristics and/or exercise intervention parameters explained CRF changes. Further analyses included cohort, cross-sectional, and observational study designs. Outcome measures of interest were absolute (A[Formula: see text]O2peak) or relative [Formula: see text]O2peak (R[Formula: see text]O2peak), and/or PPO. Bias/quality was assessed via The Cochrane Risk of Bias 2 and the National Institute of Health Quality Assessment Tools. Certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Random effects models were used in all meta-analyses and meta-regressions. Of 21,020 identified records, 120 studies comprising 29 RCTs, 67 pre-post studies, 11 cohort, 7 cross-sectional, and 6 observational studies were included. The primary meta-analysis revealed significant improvements in A[Formula: see text]O2peak [0.16 (0.07, 0.25) L/min], R[Formula: see text]O2peak [2.9 (1.8, 3.9) mL/kg/min], and PPO [9 (5, 14) W] with exercise, relative to controls (p < 0.001). Ninety-six studies (117 independent exercise interventions comprising 1,331 adults with SCI) were included in the secondary, pooled meta-analysis which demonstrated significant increases in A[Formula: see text]O2peak [0.22 (0.17, 0.26) L/min], R[Formula: see text]O2peak [2.8 (2.2, 3.3) mL/kg/min], and PPO [11 (9, 13) W] (p < 0.001) following exercise interventions. There were subgroup differences for R[Formula: see text]O2peak based on exercise modality (p = 0.002) and intervention length (p = 0.01), but there were no differences for A[Formula: see text]O2peak. There were subgroup differences (p ≤ 0.018) for PPO based on time since injury, neurological level of injury, exercise modality, and frequency. The meta-regression found that studies with a higher mean age of participants were associated with smaller changes in A[Formula: see text]O2peak and R[Formula: see text]O2peak (p < 0.10). GRADE indicated a moderate level of certainty in the estimated effect for R[Formula: see text]O2peak, but low levels for A[Formula: see text]O2peak and PPO. This review may be limited by the small number of RCTs, which prevented a subgroup analysis within this specific study design. CONCLUSIONS Our primary meta-analysis confirms that performing exercise >2 weeks results in significant improvements to A[Formula: see text]O2peak, R[Formula: see text]O2peak, and PPO in individuals with SCI. The pooled meta-analysis subgroup comparisons identified that exercise interventions lasting up to 12 weeks yield the greatest change in R[Formula: see text]O2peak. Upper-body aerobic exercise and resistance training also appear the most effective at improving R[Formula: see text]O2peak and PPO. Furthermore, acutely injured, individuals with paraplegia, exercising for ≥3 sessions/week will likely experience the greatest change in PPO. Ageing seemingly diminishes the adaptive CRF responses to exercise training in individuals with SCI. REGISTRATION PROSPERO: CRD42018104342.
Collapse
Affiliation(s)
- Daniel D. Hodgkiss
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Gurjeet S. Bhangu
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- MD Undergraduate Program, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Carole Lunny
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, and University of British Columbia, Vancouver, Canada
| | - Catherine R. Jutzeler
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Schulthess Clinic, Zurich, Switzerland
| | - Shin-Yi Chiou
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, United Kingdom
- Centre for Trauma Science Research, University of Birmingham, Birmingham, United Kingdom
| | - Matthias Walter
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Samuel J. E. Lucas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
| | - Andrei V. Krassioukov
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, Canada
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada
| | - Tom E. Nightingale
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- Centre for Trauma Science Research, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
7
|
Dai CQ, Gao M, Lin XD, Xue BJ, Liang Y, Xu ML, Wu XB, Cheng GQ, Hu X, Zhao CG, Yuan H, Sun XL. Primary motor hand area corticospinal excitability indicates overall functional recovery after spinal cord injury. Front Neurol 2023; 14:1175078. [PMID: 37333013 PMCID: PMC10273270 DOI: 10.3389/fneur.2023.1175078] [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: 02/27/2023] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Background After spinal cord injury (SCI), the excitability of the primary motor cortex (M1) lower extremity area decreases or disappears. A recent study reported that the M1 hand area of the SCI patient encodes the activity information of both the upper and lower extremities. However, the characteristics of the M1 hand area corticospinal excitability (CSE) changes after SCI and its correlation with extremities motor function are still unknown. Methods A retrospective study was conducted on the data of 347 SCI patients and 80 healthy controls on motor evoked potentials (MEP, reflection of CSE), extremity motor function, and activities of daily living (ADL) ability. Correlation analysis and multiple linear regression analysis were conducted to analyze the relationship between the degree of MEP hemispheric conversion and extremity motor function/ADL ability. Results The CSE of the dominant hemisphere M1 hand area decreased in SCI patients. In 0-6 m, AIS A grade, or non-cervical injury SCI patients, the degree of M1 hand area MEP hemispheric conversion was positively correlated with total motor score, lower extremity motor score (LEMS), and ADL ability. Multiple linear regression analysis further confirmed the contribution of MEP hemispheric conversion degree in ADL changes as an independent factor. Conclusion The closer the degree of M1 hand area MEP hemispheric conversion is to that of healthy controls, the better the extremity motor function/ADL ability patients achieve. Based on the law of this phenomenon, targeted intervention to regulate the excitability of bilateral M1 hand areas might be a novel strategy for SCI overall functional recovery.
Collapse
Affiliation(s)
- Chun-Qiu Dai
- Department of Rehabilitation Medicine, Xi-Jing Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, China
- Lintong Rehabilitation and Convalescent Centre, Xi'an, China
| | - Ming Gao
- Department of Rehabilitation Medicine, Xi-Jing Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, China
| | - Xiao-Dong Lin
- Department of Rehabilitation Medicine, Xi-Jing Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, China
| | - Bai-Jie Xue
- Department of Rehabilitation Medicine, Xi-Jing Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, China
| | - Ying Liang
- Department of Health Statistics, Air Force Medical University (Fourth Military Medical University), Xi’an, China
| | - Mu-Lan Xu
- Department of Rehabilitation Medicine, Xi-Jing Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, China
| | - Xiang-Bo Wu
- Department of Rehabilitation Medicine, Xi-Jing Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, China
| | - Gui-Qing Cheng
- Department of Rehabilitation Medicine, Xi-Jing Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, China
| | - Xu Hu
- Department of Rehabilitation Medicine, Xi-Jing Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, China
| | - Chen-Guang Zhao
- Department of Rehabilitation Medicine, Xi-Jing Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, China
| | - Hua Yuan
- Department of Rehabilitation Medicine, Xi-Jing Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, China
| | - Xiao-Long Sun
- Department of Rehabilitation Medicine, Xi-Jing Hospital, Air Force Medical University (Fourth Military Medical University), Xi’an, China
| |
Collapse
|
8
|
Huang LY, Sun X, Pan HX, Wang L, He CQ, Wei Q. Cell transplantation therapies for spinal cord injury focusing on bone marrow mesenchymal stem cells: Advances and challenges. World J Stem Cells 2023; 15:385-399. [PMID: 37342219 PMCID: PMC10277963 DOI: 10.4252/wjsc.v15.i5.385] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/17/2023] [Accepted: 03/21/2023] [Indexed: 05/26/2023] Open
Abstract
Spinal cord injury (SCI) is a devastating condition with complex pathological mechanisms that lead to sensory, motor, and autonomic dysfunction below the site of injury. To date, no effective therapy is available for the treatment of SCI. Recently, bone marrow-derived mesenchymal stem cells (BMMSCs) have been considered to be the most promising source for cellular therapies following SCI. The objective of the present review is to summarize the most recent insights into the cellular and molecular mechanism using BMMSC therapy to treat SCI. In this work, we review the specific mechanism of BMMSCs in SCI repair mainly from the following aspects: Neuroprotection, axon sprouting and/or regeneration, myelin regeneration, inhibitory microenvironments, glial scar formation, immunomodulation, and angiogenesis. Additionally, we summarize the latest evidence on the application of BMMSCs in clinical trials and further discuss the challenges and future directions for stem cell therapy in SCI models.
Collapse
Affiliation(s)
- Li-Yi Huang
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu 610044, Sichuan Province, China
| | - Xin Sun
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu 610044, Sichuan Province, China
| | - Hong-Xia Pan
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu 610044, Sichuan Province, China
| | - Lu Wang
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu 610044, Sichuan Province, China
| | - Cheng-Qi He
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu 610044, Sichuan Province, China
| | - Quan Wei
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu 610044, Sichuan Province, China
| |
Collapse
|
9
|
Jutzeler CR, Bourguignon L, Tong B, Ronca E, Bailey E, Harel NY, Geisler F, Ferguson AR, Kwon BK, Cragg JJ, Grassner L, Kramer JLK. Pharmacological management of acute spinal cord injury: a longitudinal multi-cohort observational study. Sci Rep 2023; 13:5434. [PMID: 37012257 PMCID: PMC10070428 DOI: 10.1038/s41598-023-31773-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 03/16/2023] [Indexed: 04/05/2023] Open
Abstract
Multiple types and classes of medications are administered in the acute management of traumatic spinal cord injury. Prior clinical studies and evidence from animal models suggest that several of these medications could modify (i.e., enhance or impede) neurological recovery. We aimed to systematically determine the types of medications commonly administered, alone or in combination, in the transition from acute to subacute spinal cord injury. For that purpose, type, class, dosage, timing, and reason for administration were extracted from two large spinal cord injury datasets. Descriptive statistics were used to describe the medications administered within the first 60 days after spinal cord injury. Across 2040 individuals with spinal cord injury, 775 unique medications were administered within the two months after injury. On average, patients enrolled in a clinical trial were administered 9.9 ± 4.9 (range 0-34), 14.3 ± 6.3 (range 1-40), 18.6 ± 8.2 (range 0-58), and 21.5 ± 9.7 (range 0-59) medications within the first 7, 14, 30, and 60 days post-injury, respectively. Those enrolled in an observational study were administered on average 1.7 ± 1.7 (range 0-11), 3.7 ± 3.7 (range 0-24), 8.5 ± 6.3 (range 0-42), and 13.5 ± 8.3 (range 0-52) medications within the first 7, 14, 30, and 60 days post-injury, respectively. Polypharmacy was commonplace (up to 43 medications per day per patient). Approximately 10% of medications were administered acutely as prophylaxis (e.g., against the development of pain or infections). To our knowledge, this was the first time acute pharmacological practices have been comprehensively examined after spinal cord injury. Our study revealed a high degree of polypharmacy in the acute stages of spinal cord injury, raising the potential to impact neurological recovery. All results can be interactively explored on the RXSCI web site ( https://jutzelec.shinyapps.io/RxSCI/ ) and GitHub repository ( https://github.com/jutzca/Acute-Pharmacological-Treatment-in-SCI/ ).
Collapse
Affiliation(s)
- Catherine R Jutzeler
- Department of Health Sciences and Technology, ETH Zurich, Lengghalde 2, 8008, Zurich, Switzerland.
| | - Lucie Bourguignon
- Department of Health Sciences and Technology, ETH Zurich, Lengghalde 2, 8008, Zurich, Switzerland
| | - Bobo Tong
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
| | - Elias Ronca
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Eric Bailey
- James J Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Noam Y Harel
- James J Peters Veterans Affairs Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fred Geisler
- University of Saskatchewan, Saskatoon, SK, Canada
| | - Adam R Ferguson
- Brain and Spinal Injury Center, Weill Institute for Neurosciences, University of California San Francisco (UCSF), San Francisco, CA, USA
- San Francisco Veteran's Affairs Health Care System, San Francisco, CA, USA
| | - Brian K Kwon
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
| | - Jacquelyn J Cragg
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Lukas Grassner
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
- Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - John L K Kramer
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Hugill Centre for Anesthesia, University of British Columbia, Vancouver, Canada
| |
Collapse
|
10
|
Segmental motor recovery after cervical spinal cord injury relates to density and integrity of corticospinal tract projections. Nat Commun 2023; 14:723. [PMID: 36759606 PMCID: PMC9911610 DOI: 10.1038/s41467-023-36390-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023] Open
Abstract
Cervical spinal cord injury (SCI) causes extensive impairments for individuals which may include dextrous hand function. Although prior work has focused on the recovery at the person-level, the factors determining the recovery of individual muscles are poorly understood. Here, we investigate the muscle-specific recovery after cervical spinal cord injury in a retrospective analysis of 748 individuals from the European Multicenter Study about Spinal Cord Injury (NCT01571531). We show associations between corticospinal tract (CST) sparing and upper extremity recovery in SCI, which improves the prediction of hand muscle strength recovery. Our findings suggest that assessment strategies for muscle-specific motor recovery in acute spinal cord injury are improved by accounting for CST sparing, and complement person-level predictions.
Collapse
|
11
|
Lee BJ, Jeong JH. Early Decompression in Acute Spinal Cord Injury : Review and Update. J Korean Neurosurg Soc 2023; 66:6-11. [PMID: 36274255 PMCID: PMC9837486 DOI: 10.3340/jkns.2022.0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/25/2022] [Accepted: 07/01/2022] [Indexed: 01/25/2023] Open
Abstract
Spinal cord injury (SCI) has a significant negative effect on the quality of life due to permanent neurologic damage and economic burden by continuous treatment and rehabilitation. However, determining the correct approach to ensure optimal clinical outcomes can be challenging and remains highly controversial. In particular, with the introduction of the concept of early decompression in brain pathology, the discussion of the timing of decompression in SCI has emerged. In addition to that, the concept of "time is spine" has been added recently, and the mortality and complications caused by SCI have been reduced by providing timely and professional treatment to patients. However, there are many difficulties in establishing international clinical guidelines for the timing of early decompression in SCI because policies for each country and medical institution differ according to the circumstances of medical infrastructure and economic conditions in the surgical treatment of SCI. Therefore, we aim to provide a current review of timing of early decompression in patient with SCI.
Collapse
Affiliation(s)
- Byung-Jou Lee
- Department of Neurosurgery and Neuroscience & Radiosurgery Hybrid Research Center, Inje University Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Korea
| | - Je Hoon Jeong
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| |
Collapse
|
12
|
McNaughton KMD, Witherow JL, Dupuche CB, Peebles KC, Elphick TG, Hudson AL, McCaughey EJ, Boswell-Ruys CL, Butler JE. Inspiratory muscle reflex control after incomplete cervical spinal cord injury. J Appl Physiol (1985) 2022; 133:1318-1326. [PMID: 36356259 DOI: 10.1152/japplphysiol.00113.2022] [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: 11/12/2022] Open
Abstract
In healthy individuals, loading inspiratory muscles by brief inspiratory occlusion produces a short-latency inhibitory reflex (IR) in the electromyographic (EMG) activity of scalene and diaphragm muscles. This IR may play a protective role to prevent aspiration and airway collapse during sleep. In people with motor and sensory complete cervical spinal cord injury (cSCI), who were able to breathe independently, this IR was predominantly absent. Here, we investigated the reflex response to brief airway occlusion in 16 participants with sensory incomplete cSCI [American spinal injury association impairment scale (AIS) score B or C]. Surface EMG was recorded from scalene muscles and the lateral chest wall (overlying diaphragm). The airway occlusion evoked a small change in mouth pressure resembling a physiological occlusion. The short-latency IR was present in 10 (63%) sensory incomplete cSCI participants; significantly higher than the IR incidence observed in complete cSCI participants in our previous study (14%; P = 0.003). When present, mean IR latency across all muscles was 58 ms (range 29-79 ms), and mean rectified EMG amplitude decreased to 37% preocclusion levels. Participants without an IR had untreated severe obstructive sleep apnea (OSA), in contrast to those with an IR, who had either had no, mild, or treated OSA (P = 0.002). Insufficient power did not allow statistical comparison between IR presence or absence and participant clinical characteristics. In conclusion, spared sensory connections or intersegmental connections may be necessary to generate the IR. Future studies to establish whether IR presence is related to respiratory morbidity in the tetraplegic population are required.NEW & NOTEWORTHY Individuals with incomplete cSCI were tested for the presence of a short latency reflex inhibition of inspiratory muscles, by brief airway occlusion. The reflex was 4.5 times more prevalent in this group compared with those with complete cSCI and is similar to the incidence in able-bodied people. Participants without this reflex all had untreated severe OSA, in contrast to those with an IR, who either had no, mild, or treated OSA. This work reveals novel differences in the reflex control of inspiratory muscles across the cSCI population.
Collapse
Affiliation(s)
- Keith M D McNaughton
- Neuroscience Research Australia, Randwick, New South Wales, Australia.,Department of Health Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Jessica L Witherow
- Department of Health Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Crystal B Dupuche
- Department of Health Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Karen C Peebles
- Department of Health Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Tom G Elphick
- School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia
| | - Anna L Hudson
- Neuroscience Research Australia, Randwick, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Euan J McCaughey
- Neuroscience Research Australia, Randwick, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia.,Queen Elizabeth National Spinal Injuries Unit, Glasgow, United Kingdom
| | - Claire L Boswell-Ruys
- Neuroscience Research Australia, Randwick, New South Wales, Australia.,Department of Physiotherapy, Prince of Wales Hospital, Randwick, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia
| | - Jane E Butler
- School of Medical Sciences, University of New South Wales, Kensington, New South Wales, Australia
| |
Collapse
|
13
|
Intraoperative Sensory Signals Predict Prognosis for Patients with Traumatic Cervical Spinal Cord Injury. World Neurosurg 2022; 168:e393-e398. [DOI: 10.1016/j.wneu.2022.10.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 11/11/2022]
|
14
|
Shang Z, Wang M, Zhang B, Wang X, Wanyan P. Clinical translation of stem cell therapy for spinal cord injury still premature: results from a single-arm meta-analysis based on 62 clinical trials. BMC Med 2022; 20:284. [PMID: 36058903 PMCID: PMC9442938 DOI: 10.1186/s12916-022-02482-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND How much scientific evidence is there to show that stem cell therapy is sufficient in preclinical and clinical studies of spinal cord injury before it is translated into clinical practice? This is a complicated problem. A single, small-sample clinical trial is difficult to answer, and accurate insights into this question can only be given by systematically evaluating all the existing evidence. METHODS The PubMed, Ovid-Embase, Web of Science, and Cochrane databases were searched from inception to February 10, 2022. Two independent reviewers performed the literature search, identified and screened the studies, and performed a quality assessment and data extraction. RESULTS In total, 62 studies involving 2439 patients were included in the analysis. Of these, 42 were single-arm studies, and 20 were controlled studies. The meta-analysis showed that stem cells improved the ASIA impairment scale score by at least one grade in 48.9% [40.8%, 56.9%] of patients with spinal cord injury. Moreover, the rate of improvement in urinary and gastrointestinal system function was 42.1% [27.6%, 57.2%] and 52.0% [23.6%, 79.8%], respectively. However, 28 types of adverse effects were observed to occur due to stem cells and transplantation procedures. Of these, neuropathic pain, abnormal feeling, muscle spasms, vomiting, and urinary tract infection were the most common, with an incidence of > 20%. While no serious adverse effects such as tumorigenesis were reported, this could be due to the insufficient follow-up period. CONCLUSIONS Overall, the results demonstrated that although the efficacy of stem cell therapy is encouraging, the subsequent adverse effects remain concerning. In addition, the clinical trials had problems such as small sample sizes, poor design, and lack of prospective registration, control, and blinding. Therefore, the current evidence is not sufficiently strong to support the clinical translation of stem cell therapy for spinal cord injury, and several problems remain. Additional well-designed animal experiments and high-quality clinical studies are warranted to address these issues.
Collapse
Affiliation(s)
- Zhizhong Shang
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, China
| | - Mingchuan Wang
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, China
| | - Baolin Zhang
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, China
| | - Xin Wang
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, China.
- Chengren Institute of Traditional Chinese Medicine, Lanzhou, 730000, Gansu Province, China.
- Department of Spine, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China.
| | - Pingping Wanyan
- Gansu University of Chinese Medicine, Lanzhou, 730000, China
- The Second Hospital of Lanzhou University, Lanzhou, 730000, China
| |
Collapse
|
15
|
Franz S, Eck U, Schuld C, Heutehaus L, Wolf M, Wilder-Smith E, Schulte-Mattler W, Weber MA, Rupp R, Weidner N. Lower motoneuron dysfunction impacts spontaneous motor recovery in acute cervical spinal cord injury. J Neurotrauma 2022; 40:862-875. [PMID: 36006372 PMCID: PMC10162119 DOI: 10.1089/neu.2022.0181] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Paresis after spinal cord injury is caused by damage to upper and lower motoneurons and may differentially impact neurological recovery. This prospective monocentric longitudinal observational study investigated the extent and severity of lower motoneuron dysfunction and its impact on upper extremity motor recovery after acute cervical spinal cord injury. Pathological spontaneous activity at rest and/or increased discharge rates of motor unit action potentials recorded by needle electromyography (EMG) were taken as parameters for lower motoneuron dysfunction and its relation to the extent of myelopathy in the first available spine MRI was determined. Motor recovery was assessed by standardized neurological examination within the first 4 weeks (acute stage) and up to 1 year (chronic stage) after injury. Eighty-five muscles of 17 individuals with cervical spinal cord injury (neurological level of injury from C1 to C7) and a median age of 54 (28-59) were examined. The results showed that muscles with signs of lower motoneuron dysfunction peaked at the lesion center (Χ²[2,n=85]=6.6, p=0.04) and that the severity of lower motoneuron dysfunction correlated with T2-weighted hyperintense MRI signal changes in routine spine MRI at the lesion site (spearman ρ=0.31, p=0.01). Muscles exhibiting signs of lower motoneuron dysfunction, as indicated by pathological spontaneous activity at rest and/or increased discharge rates of motor unit action potentials, were associated with more severe paresis in both the acute and chronic stages after spinal cord injury (spearman ρ acute=-0.22, p=0.04 and chronic=-0.31, p=0.004). Moreover, the severity of lower motoneuron dysfunction in the acute stage was also associated with a greater degree of paresis (spearman ρ acute=-0.24, p=0.03 and chronic=-0.35, p=0.001). While both muscles with and without signs of lower motoneuron dysfunction were capable of regaining strength over time, those without lower motoneuron dysfunctions had a higher potential to reach full strength. Muscles with signs of lower motoneuron dysfunction in the acute stage displayed increased amplitudes of motor unit action potentials with chronic-stage needle EMG, indicating reinnervation through peripheral collateral sprouting as compensatory mechanism (Χ²[1,n=72]=4.3, p=0.04). Thus, lower motoneuron dysfunction represents a relevant factor contributing to motor impairment and recovery in acute cervical spinal cord injury. Defined recovery mechanisms (peripheral reinnervation) may at least partially underlie spontaneous recovery in respective muscles. Therefore, assessment of lower motoneuron dysfunction could help refine prediction of motor recovery following spinal cord injury.
Collapse
Affiliation(s)
- Steffen Franz
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
- Address correspondence to: Steffen Franz, MD, Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstraße 200 a, 69118 Heidelberg, Germany
| | - Ute Eck
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Schuld
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Laura Heutehaus
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Marcel Wolf
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Einar Wilder-Smith
- Department of Neurology, Kantonsspital Lucerne, Lucerne, Switzerland
- Department of Neurology, Inselspital Bern, University of Bern, Bern, Switzerland
| | | | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Rüdiger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| |
Collapse
|
16
|
Sinopoulou E, Spejo AB, Roopnarine N, Burnside ER, Bartus K, De Winter F, McMahon SB, Bradbury EJ. Chronic muscle recordings reveal recovery of forelimb function in spinal injured female rats after cortical epidural stimulation combined with rehabilitation and chondroitinase ABC. J Neurosci Res 2022; 100:2055-2076. [PMID: 35916483 PMCID: PMC9544922 DOI: 10.1002/jnr.25111] [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: 08/10/2020] [Revised: 06/23/2022] [Accepted: 07/09/2022] [Indexed: 11/11/2022]
Abstract
Cervical level spinal cord injury (SCI) can severely impact upper limb muscle function, which is typically assessed in the clinic using electromyography (EMG). Here, we established novel preclinical methodology for EMG assessments of muscle function after SCI in awake freely moving animals. Adult female rats were implanted with EMG recording electrodes in bicep muscles and received bilateral cervical (C7) contusion injuries. Forelimb muscle activity was assessed by recording maximum voluntary contractions during a grip strength task and cortical motor evoked potentials in the biceps. We demonstrate that longitudinal recordings of muscle activity in the same animal are feasible over a chronic post-injury time course and provide a sensitive method for revealing post-injury changes in muscle activity. This methodology was utilized to investigate recovery of muscle function after a novel combination therapy. Cervical contused animals received intraspinal injections of a neuroplasticity-promoting agent (lentiviral-chondroitinase ABC) plus 11 weeks of cortical epidural electrical stimulation (3 h daily, 5 days/week) and behavioral rehabilitation (15 min daily, 5 days/week). Longitudinal monitoring of voluntary and evoked muscle activity revealed significantly increased muscle activity and upper limb dexterity with the combination treatment, compared to a single treatment or no treatment. Retrograde mapping of motor neurons innervating the biceps showed a predominant distribution across spinal segments C5-C8, indicating that treatment effects were likely due to neuroplastic changes in a mixture of intact and injured motor neurons. Thus, longitudinal assessments of muscle function after SCI correlate with skilled reach and grasp performance and reveal functional benefits of a novel combination therapy.
Collapse
Affiliation(s)
- Eleni Sinopoulou
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, Regeneration Group, The Wolfson Centre for Age-Related Diseases, London, UK.,Department of Neuroscience, The Center for Neural Repair, University of California, San Diego, California, USA
| | - Aline Barroso Spejo
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, Regeneration Group, The Wolfson Centre for Age-Related Diseases, London, UK
| | - Naomi Roopnarine
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, Regeneration Group, The Wolfson Centre for Age-Related Diseases, London, UK
| | - Emily R Burnside
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, Regeneration Group, The Wolfson Centre for Age-Related Diseases, London, UK
| | - Katalin Bartus
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, Regeneration Group, The Wolfson Centre for Age-Related Diseases, London, UK
| | - Fred De Winter
- Laboratory for Neuroregeneration, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
| | - Stephen B McMahon
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, Regeneration Group, The Wolfson Centre for Age-Related Diseases, London, UK
| | - Elizabeth J Bradbury
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, Regeneration Group, The Wolfson Centre for Age-Related Diseases, London, UK
| |
Collapse
|
17
|
Dengler J, Steeves JD, Curt A, Mehra M, Novak CB, Fox IK. Spontaneous Motor Recovery after Cervical Spinal Cord Injury: Issues for Nerve Transfer Surgery Decision Making. Spinal Cord 2022; 60:922-927. [PMID: 35896613 DOI: 10.1038/s41393-022-00834-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To quantify spontaneous upper extremity motor recovery between 6 and 12 months after spinal cord injury (SCI) to help guide timing of nerve transfer surgery to improve upper limb function in cervical SCI. SETTING Nineteen European SCI rehabilitation centers. METHODS Data was extracted from the European Multicenter Study of SCI database for individuals with mid-level cervical SCI (N = 268). Muscle function grades at 6 and 12 months post-SCI were categorized for analysis. RESULTS From 6 to 12 months after SCI, spontaneous surgically-relevant recovery was limited. Of all limbs (N = 263) with grade 0-2 elbow extension at 6 months, 4% regained grade 4-5 and 11% regained grade 3 muscle function at 12 months. Of all limbs (N = 380) with grade 0-2 finger flexion at 6 months, 3% regained grade 4-5 and 5% regained grade 3 muscle function at 12 months. CONCLUSION This information supports early (6 month) post-injury surgical consultation and evaluation. With this information, individuals with SCI can more fully engage in preference-based decision-making about surgical intervention versus continued rehabilitation and spontaneous recovery to gain elbow extension and/or hand opening and closing.
Collapse
Affiliation(s)
- Jana Dengler
- Division of Plastic and Reconstructive Surgery, Tory Trauma Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,University of Toronto, Division of Plastic & Reconstructive Surgery, Toronto, Ontario, Canada
| | - John D Steeves
- ICORD, University of British Columbia, Vancouver British Columbia, Vancouver, Canada
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Munish Mehra
- Tigermed-BDM Inc, Gaithersburg Maryland, Maryland, USA
| | - Christine B Novak
- University of Toronto, Division of Plastic & Reconstructive Surgery, Toronto, Ontario, Canada
| | | | | | - Ida K Fox
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis Missouri, USA. .,VA St. Louis Healthcare System, St Louis Missouri, USA.
| |
Collapse
|
18
|
Pathophysiology, Classification and Comorbidities after Traumatic Spinal Cord Injury. J Pers Med 2022; 12:jpm12071126. [PMID: 35887623 PMCID: PMC9323191 DOI: 10.3390/jpm12071126] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/26/2022] [Accepted: 06/27/2022] [Indexed: 12/25/2022] Open
Abstract
The spinal cord is a conduit within the central nervous system (CNS) that provides ongoing communication between the brain and the rest of the body, conveying complex sensory and motor information necessary for safety, movement, reflexes, and optimization of autonomic function. After a spinal cord injury (SCI), supraspinal influences on the spinal segmental control system and autonomic nervous system (ANS) are disrupted, leading to spastic paralysis, pain and dysesthesia, sympathetic blunting and parasympathetic dominance resulting in cardiac dysrhythmias, systemic hypotension, bronchoconstriction, copious respiratory secretions and uncontrolled bowel, bladder, and sexual dysfunction. This article outlines the pathophysiology of traumatic SCI, current and emerging methods of classification, and its influence on sensory/motor function, and introduces the probable comorbidities associated with SCI that will be discussed in more detail in the accompanying manuscripts of this special issue.
Collapse
|
19
|
Silverman J, Dengler J, Song C, Robinson LR. Pre-operative electrodiagnostic planning for upper limb peripheral nerve transfers in cervical spinal cord injury: A Narrative Review. PM R 2022. [PMID: 35726540 DOI: 10.1002/pmrj.12868] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 02/13/2022] [Accepted: 05/31/2022] [Indexed: 11/08/2022]
Abstract
Peripheral nerve transfer (PNT) to improve upper limb function following cervical spinal cord injury (SCI) involves the transfer of supralesional donor nerves under voluntary control to intralesional or sublesional lower motor neurons not under voluntary control. Appropriate selection of donor and recipient nerves and surgical timing impact functional outcomes. While the gold standard of nerve selection is intra-operative nerve stimulation, preoperative electrodiagnostic (EDX) evaluation may help guide surgical planning. Currently there is no standardized preoperative EDX protocol. This study reviews the EDX workup preceding peripheral nerve transfer surgery in cervical SCI, and proposes an informed EDX protocol to assist with surgical planning. The PICO (Population, Intervention, Comparison, Outcome) framework was used to formulate relevant MeSH terms and identify published cases of PNT in cervical SCI in Medline, Embase, CINAHL, and Emcare databases in the last 10 years. The electrodiagnostic techniques evaluating putative donor nerves, recipient nerve branches, time-sensitivity of nerve transfer and other electrophysiological parameters were summarized to guide creation of a preoperative EDX protocol. Needle electromyography (EMG) was the most commonly used EDX technique to identify healthy donor nerves. Although needle EMG has also been used on recipient nerves, compound muscle action potential (CMAP) amplitudes may provide a more accurate determination of recipient nerve health and time-sensitivity for nerve transfer. While there has been progress in pre-surgical EDX evaluation, EMG and NCS approaches are quite variable, and each has limitations in their utility for pre-operative planning. There is need for standardization in the EDX evaluation preceding peripheral nerve transfer surgery to assist with donor and recipient nerve selection, surgical timing and to optimize outcomes. Based on results of this review, herein we propose the PreSCIse (PRotocol for Electrodiagnosis in SCI Surgery of the upper Extremity) pre-operative EDX panel to achieve said goals through an interdisciplinary and patient-centered approach. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Jordan Silverman
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jana Dengler
- Division of Plastic and Reconstructive Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Cimon Song
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lawrence R Robinson
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
20
|
L'Hotta AJ, James AS, Curtin CM, Kennedy C, Kenney D, Tam K, Ota D, Stenson K, Novak CB, Fox IK. Surgery to Restore Upper Extremity Function in Tetraplegia-Preferences for Early and Frequent Access to Information. PM R 2022. [PMID: 35665476 DOI: 10.1002/pmrj.12862] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/25/2022] [Accepted: 05/06/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION People with cervical spinal cord injury (SCI) identify improving upper extremity (UE) function as a top priority. In addition to comprehensive rehabilitation, UE surgeries, including nerve and tendon transfers, enhance function. However, barriers exist to disseminating information about surgical options to enhance UE function. OBJECTIVE To assess the experiences and preferences of people with cervical SCI and their caregivers in accessing information about surgery to enhance UE function. DESIGN Prospective cohort study. Participants were followed for 24 months and completed up to three interviews. SETTING Tertiary care at academic and affiliated Veterans Administration Health Care Centers. PARTICIPANTS Adults with cervical SCI (n=35) ages 18 to 80 years with mid-cervical SCI American Spinal Injury Association Impairment Scale A, B, or C (at least six months post-injury) and their caregivers (n=23) were eligible to participate. Participants were enrolled in three groups: nerve transfer, tendon transfer, or no UE reconstructive surgery. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Semi-structured interviews about surgical knowledge and experiences. RESULTS Data were analyzed and three themes were identified. First, providing information about UE surgical options early post-injury was recommended. The acute or inpatient rehabilitation phases of recovery were the preferred times to receive surgical information. Second, challenges with information dissemination were identified. Participants learned about UE surgery through independent research, medical provider interactions, or peers. Third, peers were identified as valuable resources for SCI needs and surgical information. CONCLUSIONS Following cervical SCI, information about UE reconstructive surgeries should be a standard component of education during rehabilitation. An increased understanding of the reconstructive options available to improve UE function is necessary to educate stakeholders. Future research is needed to support the development of strategies to effectively present surgical information to individuals with SCI and healthcare providers. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
| | - Aimee S James
- Washington University School of Medicine in St. Louis
| | | | - Carie Kennedy
- Washington University School of Medicine in St. Louis
| | | | - Katharine Tam
- Washington University School of Medicine in St. Louis.,VA St. Louis Health Care System
| | | | | | | | - Ida K Fox
- Washington University School of Medicine in St. Louis.,VA St. Louis Health Care System
| |
Collapse
|
21
|
Cell-based and stem-cell-based treatments for spinal cord injury: evidence from clinical trials. Lancet Neurol 2022; 21:659-670. [DOI: 10.1016/s1474-4422(21)00464-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/01/2021] [Accepted: 12/17/2021] [Indexed: 12/22/2022]
|
22
|
Brihmat N, Allexandre D, Saleh S, Zhong J, Yue GH, Forrest GF. Stimulation Parameters Used During Repetitive Transcranial Magnetic Stimulation for Motor Recovery and Corticospinal Excitability Modulation in SCI: A Scoping Review. Front Hum Neurosci 2022; 16:800349. [PMID: 35463922 PMCID: PMC9033167 DOI: 10.3389/fnhum.2022.800349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/24/2022] [Indexed: 12/28/2022] Open
Abstract
There is a growing interest in non-invasive stimulation interventions as treatment strategies to improve functional outcomes and recovery after spinal cord injury (SCI). Repetitive transcranial magnetic stimulation (rTMS) is a neuromodulatory intervention which has the potential to reinforce the residual spinal and supraspinal pathways and induce plasticity. Recent reviews have highlighted the therapeutic potential and the beneficial effects of rTMS on motor function, spasticity, and corticospinal excitability modulation in SCI individuals. For this scoping review, we focus on the stimulation parameters used in 20 rTMS protocols. We extracted the rTMS parameters from 16 published rTMS studies involving SCI individuals and were able to infer preliminary associations between specific parameters and the effects observed. Future investigations will need to consider timing, intervention duration and dosage (in terms of number of sessions and number of pulses) that may depend on the stage, the level, and the severity of the injury. There is a need for more real vs. sham rTMS studies, reporting similar designs with sufficient information for replication, to achieve a significant level of evidence regarding the use of rTMS in SCI.
Collapse
Affiliation(s)
- Nabila Brihmat
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers—New Jersey Medical School, Newark, NJ, United States
| | - Didier Allexandre
- Department of Physical Medicine and Rehabilitation, Rutgers—New Jersey Medical School, Newark, NJ, United States
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, United States
| | - Soha Saleh
- Department of Physical Medicine and Rehabilitation, Rutgers—New Jersey Medical School, Newark, NJ, United States
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, United States
| | - Jian Zhong
- Burke Neurological Institute and Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, White Plains, NY, United States
| | - Guang H. Yue
- Department of Physical Medicine and Rehabilitation, Rutgers—New Jersey Medical School, Newark, NJ, United States
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, United States
| | - Gail F. Forrest
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers—New Jersey Medical School, Newark, NJ, United States
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, United States
- *Correspondence: Gail F. Forrest
| |
Collapse
|
23
|
Hypothermia Therapy for Traumatic Spinal Cord Injury: An Updated Review. J Clin Med 2022; 11:jcm11061585. [PMID: 35329911 PMCID: PMC8949322 DOI: 10.3390/jcm11061585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 11/16/2022] Open
Abstract
Although hypothermia has shown to protect against ischemic and traumatic neuronal death, its potential role in neurologic recovery following traumatic spinal cord injury (TSCI) remains incompletely understood. Herein, we systematically review the safety and efficacy of hypothermia therapy for TSCI. The English medical literature was reviewed using PRISMA guidelines to identify preclinical and clinical studies examining the safety and efficacy of hypothermia following TSCI. Fifty-seven articles met full-text review criteria, of which twenty-eight were included. The main outcomes of interest were neurological recovery and postoperative complications. Among the 24 preclinical studies, both systemic and local hypothermia significantly improved neurologic recovery. In aggregate, the 4 clinical studies enrolled 60 patients for treatment, with 35 receiving systemic hypothermia and 25 local hypothermia. The most frequent complications were respiratory in nature. No patients suffered neurologic deterioration because of hypothermia treatment. Rates of American Spinal Injury Association (AIS) grade conversion after systemic hypothermia (35.5%) were higher when compared to multiple SCI database control studies (26.1%). However, no statistical conclusions could be drawn regarding the efficacy of hypothermia in humans. These limited clinical trials show promise and suggest therapeutic hypothermia to be safe in TSCI patients, though its effect on neurological recovery remains unclear. The preclinical literature supports the efficacy of hypothermia after TSCI. Further clinical trials are warranted to conclusively determine the effects of hypothermia on neurological recovery as well as the ideal means of administration necessary for achieving efficacy in TSCI.
Collapse
|
24
|
Kisala PA, Boulton AJ, Slavin MD, Cohen ML, Keeney T, Ni P, Tate D, Heinemann AW, Charlifue S, Fyffe DC, Felix ER, Jette AM, Tulsky DS. Spinal Cord Injury-Functional Index/Capacity: Responsiveness to Change Over Time. Arch Phys Med Rehabil 2022; 103:199-206. [PMID: 34717921 PMCID: PMC8810572 DOI: 10.1016/j.apmr.2021.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 09/21/2021] [Accepted: 10/01/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To establish responsiveness of 3 Spinal Cord Injury-Functional Index/Capacity (SCI-FI/C) item banks in the first year after spinal cord injury (SCI). DESIGN Longitudinal patient-reported outcomes assessment replicated through secondary analysis of an independent data set. SETTING A total of 8 SCI Model Systems rehabilitation hospitals in the United States. PARTICIPANTS Study 1 participants included 184 adults with recent (≤4 months) traumatic SCI and 221 community-dwelling adults (>1 year post injury) (N=405). Study 2 participants were 418 individuals with recent SCI (≤4 months) (N=418). INTERVENTIONS In study 1, SCI-FI/C computer adaptive tests were presented in a standardized interview format either in person or by phone call at baseline and 6-month follow-up. Responsiveness was examined by comparing 6-month changes in SCI-FI scores within and across samples (recently injured vs community-dwelling) because only the recent injury sample was expected to exhibit change over time. Effect sizes were also computed. In study 2, the study 1 results were cross-validated in a second sample with recent SCI 1 year after baseline measurement. Study 2 also compared the SCI-FI/C measures' responsiveness to that of the Self-reported Functional Measure (SRFM) and stratified results by injury diagnosis and completeness. MAIN OUTCOME MEASURES The SCI-FI Basic Mobility/C, Self-care/C and Fine Motor/C item banks (study 1 and study 2); Self-reported Functional Measure SRFM (study 2 only). RESULTS In study 1, changes in SCI-FI/C scores between baseline and 6-month follow-up were statistically significant (P<.01) for recently injured individuals. SCI-FI Basic Mobility/C, Self-care/C, and Fine Motor/C item banks demonstrated small to medium effect sizes in the recently injured sample. In the community-dwelling sample, all SCI-FI/C effects were negligible (ie, effect size<0.08). Study 2 results were similar to study 1. As expected, SCI-FI Basic Mobility/C and Self-care/C were responsive to change for all individuals in study 2, whereas the SCI-FI Fine Motor/C was responsive only for individuals with tetraplegia and incomplete paraplegia. The SRFM demonstrated a medium effect size for responsiveness (effect size=0.65). CONCLUSIONS The SCI-FI Basic Mobility/C and Self-care/C banks demonstrate adequate sensitivity to change at 6 months and 1 year for all individuals with SCI, while the SCI-FI/C Fine Motor item bank is sensitive to change in individuals with tetraplegia or incomplete paraplegia. All SCI-FI/C banks demonstrate stability in a sample not expected to change. Results provide support for the use of these measures for research or clinical use.
Collapse
Affiliation(s)
- Pamela A. Kisala
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE
| | - Aaron J. Boulton
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE
| | - Mary D. Slavin
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
| | - Matthew L. Cohen
- Dept. of Communication Sciences and Disorders and Center for Health Assessment Research and Translation, University of Delaware, Newark, DE
| | - Tamra Keeney
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital,Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital
| | - Pengsheng Ni
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
| | - Denise Tate
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Allen W. Heinemann
- Shirley Ryan AbilityLab and Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Denise C. Fyffe
- Kessler Foundation, West Orange, NJ and New Jersey Medical School, Newark, NJ
| | - Elizabeth R. Felix
- Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, FL
| | - Alan M. Jette
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital
| | - David S. Tulsky
- Center for Health Assessment Research and Translation and Departments of Physical Therapy and Psychological and Brain Sciences, University of Delaware, Newark, DE
| |
Collapse
|
25
|
Kasch H, Løve US, Jønsson AB, Severinsen KE, Possover M, Elmgreen SB, Forman A. Effect of pelvic laparoscopic implantation of neuroprosthesis in spinal cord injured subjects: a 1-year prospective randomized controlled study. Spinal Cord 2022; 60:251-255. [PMID: 34429511 PMCID: PMC8904257 DOI: 10.1038/s41393-021-00693-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 02/06/2023]
Abstract
STUDY DESIGN 1-year prospective RCT. OBJECTIVE Examine the effect of implantable pulse generator and low-frequency stimulation of the pelvic nerves using laparoscopic implantation of neuroprosthesis (LION) compared with neuromuscular electrical stimulation (NMES) in SCI. METHODS Inclusion criteria: traumatic spinal cord injury (SCI), age 18-55 years, neurological level-of-injury Th4-L1, time-since-injury >1 year, and AIS-grades A-B. Participants were randomized to (A) LION procedure or (B) control group receiving NMES. PRIMARY OUTCOME MEASURE Walking Index for Spinal Cord Injury (WISCI-II), which is a SCI specific outcome measure assessing ability to ambulate. SECONDARY OUTCOME MEASURES Spinal Cord Independence Measure III (SCIM III), Patient Global Impression of Change (PGIC), Penn Spasm Frequency Scale (PSFS), severity of spasticity measured by Numeric Rating Scale (NRS-11); International Spinal Cord Injury data sets-Quality of Life Basic Data Set (QoLBDS), and Brief Pain Inventory (BPI). RESULTS Seventeen SCI individuals, AIS grade A, neurological level ranging from Th4-L1, were randomized to the study. One individual was excluded prior to intervention. Eight participants (7 males) with a mean age (SD) of 35.5 (12.4) years were allocated to the LION procedure, 8 participants (7 males) with age of 38.8 (15.1) years were allocated to NMES. Significantly, 5 LION group participants gained 1 point on the WISCI II scale, (p < 0.013; Fisher´s exact test). WISCI II scale score did not change in controls. No significant changes were observed in the secondary outcome measures. CONCLUSION The LION procedure is a promising new treatment for individuals with SCI with significant one-year improvement in walking ability.
Collapse
Affiliation(s)
- Helge Kasch
- grid.416838.00000 0004 0646 9184Spinal Cord Injury Centre of Western Denmark, Department of Neurology, Viborg Regional Hospital, Viborg, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Uffe Schou Løve
- grid.416838.00000 0004 0646 9184Department of Surgery, Viborg Regional Hospital, Viborg, Denmark
| | - Anette Bach Jønsson
- grid.416838.00000 0004 0646 9184Spinal Cord Injury Centre of Western Denmark, Department of Neurology, Viborg Regional Hospital, Viborg, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kaare Eg Severinsen
- grid.416838.00000 0004 0646 9184Spinal Cord Injury Centre of Western Denmark, Department of Neurology, Viborg Regional Hospital, Viborg, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marc Possover
- Possover International Medical Centre, Zürich, Switzerland
| | | | - Axel Forman
- grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark ,grid.154185.c0000 0004 0512 597XDepartment of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
26
|
Tang QR, Xue H, Zhang Q, Guo Y, Xu H, Liu Y, Liu JM. Evaluation of the Clinical Efficacy of Stem Cell Transplantation in the Treatment of Spinal Cord Injury: A Systematic Review and Meta-analysis. Cell Transplant 2021; 30:9636897211067804. [PMID: 34939443 PMCID: PMC8725233 DOI: 10.1177/09636897211067804] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Stem cell transplantation has been applied to treat spinal cord injury (SCI) in
clinical trials for many years. However, the clinical efficacies of stem cell
transplantation in SCI have been quite diverse. The purpose of our study was to
systematically investigate the efficacy of stem cell transplantation in patients
with SCI. The PubMed, Web of Science, Ovid-Medline, Cochrane Library, China
National Knowledge Infrastructure, VIP, Wanfang, and SinoMed databases were
searched until October 27, 2020. Quantitative and qualitative data were analyzed
by Review Manager 5.3 and R. Nine studies (n = 328) were
included, and the overall risk of bias was moderate. The ASIA Impairment Scale
(AIS) grading improvement rate was analyzed in favor of stem cell
transplantation group [odds ratio (OR) = 6.06, 95% confidence interval (CI):
3.16–11.62, P < 0.00001]. Urodynamic indices also showed
improvement in bladder function. In subgroup analyses, the results indicated
that in patients with complete (AIS A) SCI, with the application of cell numbers
between n*(107–108), two cell types
(i.e., bone marrow–derived mesenchymal stem cells and bone marrow mononuclears),
and treatment time of more than 6 months, stem cell transplantation was more
beneficial for sensorimotor function (P < 0.05 for all
groups). The risk of fever incidence in the stem cell transplantation group was
4.22 (95% CI: 1.7–10.22, P = 0.001), and principal component
analysis (PCA) suggested it was more related to transplanted cell numbers. Thus,
stem cell transplantation can promote functional recovery in SCI patients.
Moreover, the type and quantity of transplanted stem cells and treatment time
are important factors affecting the therapeutic effect of stem cell
transplantation in SCI. Further studies are needed to evaluate the effects and
elucidate the mechanisms of these factors on stem cell therapy in SCI.
Collapse
Affiliation(s)
- Qiao-Rui Tang
- Department of Histology and Embryology,
College of Basic Medical Sciences, Jilin University, Changchun, P.R. China
| | - Hui Xue
- Department of Histology and Embryology,
College of Basic Medical Sciences, Jilin University, Changchun, P.R. China
| | - Qiao Zhang
- Department of Histology and Embryology,
College of Basic Medical Sciences, Jilin University, Changchun, P.R. China
| | - Ying Guo
- Department of Histology and Embryology,
College of Basic Medical Sciences, Jilin University, Changchun, P.R. China
| | - Hao Xu
- Department of Histology and Embryology,
College of Basic Medical Sciences, Jilin University, Changchun, P.R. China
| | - Ying Liu
- Department of Histology and Embryology,
College of Basic Medical Sciences, Jilin University, Changchun, P.R. China
| | - Jia-Mei Liu
- Department of Histology and Embryology,
College of Basic Medical Sciences, Jilin University, Changchun, P.R. China
- Ying Liu, Department of Histology and
Embryology, College of Basic Medical Sciences, Jilin University, Changchun
130021, Jilin Province, P.R. China.
| |
Collapse
|
27
|
Grassner L, Garcia-Ovejero D, Mach O, Lopez-Dolado E, Vargas-Vaquero E, Alcobendas M, Esclarin A, Sanktjohanser L, Wutte C, Becker J, Lener S, Hartmann S, Girod PP, Koegl N, Griessenauer C, Papadopoulos MC, Geisler F, Thomé C, Molina-Holgado E, Vidal J, Curt A, Scivoletto G, Guest J, Maier D, Weidner N, Rupp R, Kramer JLK, Arevalo-Martin A. A NEW SCORE BASED ON THE INTERNATIONAL STANDARDS FOR NEUROLOGICAL CLASSIFICATION OF SPINAL CORD INJURY FOR INTEGRATIVE EVALUATION OF CHANGES IN SENSORIMOTOR FUNCTIONS. J Neurotrauma 2021; 39:613-626. [PMID: 34937399 DOI: 10.1089/neu.2021.0368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Sensorimotor function of patients with spinal cord injury (SCI) is commonly assessed according to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). From the ISNCSCI segmental motor and sensory assessments, upper and lower extremity motor scores (UEMS and LEMS), sum scores of pin prick (PP) and light touch (LT) sensation, the neurological level of injury (NLI) and the classification of lesion severity according to the American Spinal Injury Association Impairment Scale (AIS) grade are derived. Changes of these parameters over time are widely used to evaluate neurological recovery. However, evaluating recovery based on a single ISNCSCI scoring or classification variable may misestimate overall recovery. Here, we propose an Integrated Neurological Change Score (INCS) based on the combination of normalized changes between two-time points of UEMS, LEMS, and total PP and LT scores. To assess the agreement of INCS with clinical judgement of meaningfulness of neurological changes, changes of ISNCSCI variables between two time-points of 88 patients from an independent cohort were rated by 20 clinical experts according to a 5-categories Likert Scale. As for individual ISNCSCI variables, neurological change measured by INCS is associated to severity (AIS grade), age and time since injury, but INCS better reflects clinical judgment about meaningfulness of neurological changes than individual ISNCSCI variables. In addition, INCS is related with changes in functional independence measured by the Spinal Cord Independence Measure (SCIM) in patients with tetraplegia. INCS may be a useful measure of overall neurological change in clinical studies.
Collapse
Affiliation(s)
- Lukas Grassner
- Innsbruck Medical University Department of Neurology and Neurosurgery, 417777, Innsbruck, Tirol, Austria.,Paracelsus Medical University Salzburg, 31507, Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Salzburg, Austria;
| | - Daniel Garcia-Ovejero
- Hospital Nacional de Parapléjicos, SESCAM, Laboratorio de Neuroinflamación, Finca La Peraleda, Toledo, Spain, 45071;
| | - Orpheus Mach
- Trauma Center Murnau, Center for Spinal Cord Injuries, Prof.-Kuentscher-Str. 8, Murnau, Germany, 82418;
| | - Elisa Lopez-Dolado
- Hospital Nacional de Paraplejicos, Physical Medicine and Rehabilitation, Toledo, Spain;
| | | | - Monica Alcobendas
- Hospital Nacional de Paraplejicos, Physical Medicine and Rehabilitation, Toledo, Spain;
| | - Ana Esclarin
- HOSPITAL NACIONAL DE PARAPLEJICOS, Physical Medicine and Rehabilitation, Finca de la Peraleda S/N, Toledo, Toledo, Spain, 45007.,Fund;
| | | | - Christof Wutte
- Trauma Center Murnau, Center for Spinal Cord Injuries, Murnau, Germany;
| | - Johannes Becker
- Trauma Center Murnau, Center for Spinal Cord Injuries, Murnau, Germany;
| | - Sara Lener
- Innsbruck Medical University Department of Neurology and Neurosurgery, 417777, Innsbruck, Tirol, Austria;
| | - Sebastian Hartmann
- Innsbruck Medical University Department of Neurology and Neurosurgery, 417777, Innsbruck, Tirol, Austria;
| | - Pierre-Pascal Girod
- Innsbruck Medical University Department of Neurology and Neurosurgery, 417777, Innsbruck, Tirol, Austria;
| | - Nikolaus Koegl
- Innsbruck Medical University Department of Neurology and Neurosurgery, 417777, Innsbruck, Tirol, Austria;
| | - Christoph Griessenauer
- Geisinger Health System, 2780, Neurosurgery, Danville, Pennsylvania, United States.,Harvard Medical School, 1811, Neurological Surgery, Boston, Massachusetts, United States;
| | - Marios C Papadopoulos
- St George's University of London, Academic Neurosurgery Unit, St George's, University of London, 1.122 Jenner Wing, Cranmer Terrace, London, United Kingdom of Great Britain and Northern Ireland, SW17 0RE;
| | - Fred Geisler
- University of Saskatchewan College of Medicine, 12371, Saskatoon, Saskatchewan, Canada;
| | - Claudius Thomé
- Medical University Innsbruck, Dept. of Neurosurgery, Anichstr. 35, Innsbruck, Austria, 6020;
| | - Eduardo Molina-Holgado
- Hospital Nacional de Parapléjicos, SESCAM, Laboratorio de Neuroinflamación, Finca La Peraleda s/n, Toledo, Spain, 45071;
| | - Joan Vidal
- Institut Guttmann, 83068, Badalona, Catalunya, Spain;
| | - Armin Curt
- University Hospital Balgrist, Spinal Cord Injury Center, Forchstrasse, Zurich, Switzerland, 8008;
| | - Giorgio Scivoletto
- IRCCS Fondazioen S. Lucia, Spinal Cord Unit, via Ardeatina 306, Rome, Italy, 00179;
| | - James Guest
- University of Miami, Neurological Surgery, 1095 NW 14th Terrace, Miami, Florida, United States, 33136;
| | - Doris Maier
- Trauma Center Murnau, Center for Spinal Cord Injuries, Murnau, Germany;
| | - Norbert Weidner
- University Hospital Heidelberg, Spinal Cord Injury Center, Schlierbacher Landstr, Heidelberg, Germany, 69118;
| | - Rüdiger Rupp
- University Hospital Heidelberg, Spinal Cord Injury Center, Schlierbacher Landstr. 200a, Heidelberg, BW, Germany, 69118;
| | - John L K Kramer
- University of British Columbia International Collaboration on Repair Discoveries, 507272, Vancouver, British Columbia, Canada;
| | - Angel Arevalo-Martin
- Hospital Nacional de Paraplejicos, Laboratory of Neuroinflammation, Finca la Peraleda, s/n, Toledo, Spain, 45071;
| |
Collapse
|
28
|
The Study of Cerebrospinal Fluid microRNAs in Spinal Cord Injury and Neurodegenerative Diseases: Methodological Problems and Possible Solutions. Int J Mol Sci 2021; 23:ijms23010114. [PMID: 35008540 PMCID: PMC8744986 DOI: 10.3390/ijms23010114] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 12/19/2022] Open
Abstract
Despite extensive research on neurological disorders, unanswered questions remain regarding the molecular mechanisms underpinning the course of these diseases, and the search continues for effective biomarkers for early diagnosis, prognosis, or therapeutic intervention. These questions are especially acute in the study of spinal cord injury (SCI) and neurodegenerative diseases. It is believed that the changes in gene expression associated with processes triggered by neurological disorders are the result of post-transcriptional gene regulation. microRNAs (miRNAs) are key regulators of post-transcriptional gene expression and, as such, are often looked to in the search for effective biomarkers. We propose that cerebrospinal fluid (CSF) is potentially a source of biomarkers since it is in direct contact with the central nervous system and therefore may contain biomarkers indicating neurodegeneration or damage to the brain and spinal cord. However, since the abundance of miRNAs in CSF is low, their isolation and detection is technically difficult. In this review, we evaluate the findings of recent studies of CSF miRNAs as biomarkers of spinal cord injury (SCI) and neurodegenerative diseases. We also summarize the current knowledge concerning the methods of studying miRNA in CSF, including RNA isolation and normalization of the data, highlighting the caveats of these approaches and possible solutions.
Collapse
|
29
|
Characterizing Natural Recovery of People With Initial Motor Complete Tetraplegia. Arch Phys Med Rehabil 2021; 103:649-656. [PMID: 34800476 DOI: 10.1016/j.apmr.2021.09.018] [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: 01/28/2021] [Revised: 08/02/2021] [Accepted: 09/17/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the differences in neurologic recovery in persons with initial cervical American Spinal Cord Injury Association Impairment Scale (AIS) grades A and B over time. DESIGN Retrospective analysis of data from people with traumatic cervical spinal cord injury (SCI) enrolled in the National Spinal Cord Injury Model Systems (SCIMS) database from 2011-2019. SETTING SCIMS centers. PARTICIPANTS Individuals (N=187) with traumatic cervical (C1-C7 motor level) SCI admitted with initial AIS grade A and B injuries within 30 days of injury, age 16 years or older, upper extremity motor score (UEMS) ≤20 on both sides, and complete neurologic data at admission and follow-up between 6 months and 2 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Conversion in AIS grades, UEMS and lower extremity motor scores (LEMS), and sensory scores. RESULTS Mean time to initial and follow-up examinations were 16.1±7.3 days and 377.5±93.4 days, respectively. Conversion from an initial cervical AIS grades A and B to motor incomplete status was 13.4% and 50.0%, respectively. The mean UEMS change for people with initial AIS grades A and B did not differ (7.8±6.5 and 8.8±6.1; P=.307), but people with AIS grade B experienced significantly higher means of LEMS change (2.3±7.4 and 8.8±13.9 (P≤.001). The increased rate of conversion to motor incomplete status from initial AIS grade B appears to be the primary driving factor of increased overall motor recovery. Individuals with initial AIS grade B had greater improvement in sensory scores. CONCLUSIONS While UEMS recovery is similar in persons with initial AIS grades A and B, the rate of conversion to motor incomplete status, LEMS, and sensory recovery are significantly different. This information is important for clinical as well as research considerations.
Collapse
|
30
|
Moon CW, Jung IY, Kim JY, Jang HN, Cho KH. Development and Evaluation of the Korean Version of Hospital-Based Transitional Rehabilitation Program Using Daily Living Home for Spinal Cord Injury. Ann Rehabil Med 2021; 45:379-392. [PMID: 34743481 PMCID: PMC8572991 DOI: 10.5535/arm.21119] [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: 06/11/2021] [Accepted: 08/02/2021] [Indexed: 11/11/2022] Open
Abstract
Objective To develop and evaluate the Korean version of a hospital-based transitional rehabilitation program (TRP), using daily living home for spinal cord injury (SCI) patients. Methods In this study, we developed the Korean version of a hospital-based TRP through domestic and overseas surveys and focus group meetings. By applying this to chronic SCI patients, we observed the functional and quality of life (QOL) changes and evaluated the degree of achievement of the core goals set for each patient during hospital-based TRP. Results Hospital-based TRP, for 21.8±3.9 days on average, was applied to four chronic SCI patients (two patients with long-term hospital stays and two homebound disabled individuals) with an average injury period of 736.8±185.4 days. The Korean version of the Spinal Cord Independence Measure (49.3±6.9 vs. 62.5±6.0; p<0.05) showed functional improvement at the end of TRP, when compared to that before the TRP. The Korean version of the World Health Organization’s QOL scale, abbreviated version (159.8±36.6 vs. 239.8±36.1; p<0.05), showed improvement in QOL. Goal attainment scaling showed a significant degree of achievement for the core goals through TRP (33.6±4.4 vs. 70.0±2.8; p<0.05). These results confirmed that the effect was maintained 1 month after the end of TRP. Additionally, two patients were successfully discharged after TRP completion, and the other two could start social activities. Conclusion The Korean version of the hospital-based TRP, applied to chronic SCI patients, showed the potential to improve the patients’ functioning and QOL and appeared to be effective in successful discharge and social participation.
Collapse
Affiliation(s)
- Chang-Won Moon
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Il-Young Jung
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Ju Young Kim
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Ha Neul Jang
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Kang Hee Cho
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| |
Collapse
|
31
|
Gour-Provencal G, Mac-Thiong JM, Feldman DE, Bégin J, Richard-Denis A. Decreasing pressure injuries and acute care length of stay in patients with acute traumatic spinal cord injury. J Spinal Cord Med 2021; 44:949-957. [PMID: 32045340 PMCID: PMC8725680 DOI: 10.1080/10790268.2020.1718265] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Identifying factors associated with the occurrence of pressure injuries (PI) during acute care and with longer length of stay (LOS), focusing on modifiable factors that can be addressed and optimized by the acute rehabilitation team. DESIGN Prospective cohort study. SETTING A single Level-1 trauma center specialized in SCI care. PARTICIPANTS A cohort of 301 patients with acute TSCI was studied. OUTCOME MEASURES The primary outcome was the occurrence of PI during acute care stay. The secondary outcome was acute care LOS. Bivariate and multivariate logistic or linear regression analyses were performed to determine the association between non-modifiable factors and outcomes (PI of any stage and acute LOS), whereas bivariate and hierarchical multivariate logistic or linear regression analyses were used for modifiable factors. RESULTS When controlling for the level and severity of the TSCI, the occurrence of pneumonia (OR = 2.1, CI = 1.1-4.1) was significantly associated with the occurrence of PI. When controlling for the level and severity of the TSCI, the occurrence of medical complications (PI, urinary tract infection and pneumonia) and lesser daily therapy resulted in significantly longer acute care LOS (P < .001). CONCLUSIONS Prevention of PI occurrence and the optimization of the acute care LOS represent crucial challenges of the acute rehabilitation team, as they are significantly associated with higher functional outcomes. Patients who develop pneumonia may benefit from more aggressive prevention strategies to reduce PI occurrence. Systematic protocols for the prevention of complications as well as greater volume of therapy interventions should be considered to optimize the acute care LOS.
Collapse
Affiliation(s)
| | - Jean-Marc Mac-Thiong
- Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
- Faculty of Medicine, Department of Surgery, University of Montreal, Montreal, Quebec, Canada
- Sainte-Justine University Hospital Research Center, Montréal, Quebec, Canada
| | - Debbie E. Feldman
- École de réadaptation, Pavillon du Parc, Université de Montréal, Québec, Canada
| | - Jean Bégin
- Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Andréane Richard-Denis
- Faculty of Medicine, Department of Medicine, University of Montreal, Montreal, Quebec, Canada
- Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| |
Collapse
|
32
|
Castanov V, Berger MJ, Ritsma B, Trier J, Hendry JM. Optimizing the timing of peripheral nerve transfers for functional re-animation in cervical spinal cord injury: a conceptual framework. J Neurotrauma 2021; 38:3365-3375. [PMID: 34715742 DOI: 10.1089/neu.2021.0247] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Loss of upper extremity function following spinal cord injury (SCI) can have devastating consequences on quality of life. Peripheral nerve transfer surgery aims to restore motor control of upper extremities following cervical SCI and is poised to revolutionize surgical management in this population. The surgery involves dividing an expendable donor nerve above the level of the spinal lesion and coapting it to a recipient nerve arising from the lesional or infralesional segment of the injured cord. In order to maximize outcomes in this complex patient population, refinements in surgical technique need to be integrated with principles of spinal cord medicine and basic science. Deciding on the ideal timing of nerve transfer surgery is one aspect of care that is critical to maximizing recovery and has received very little attention to date in the literature. This complex topic is reviewed, with a focus on expectations for spontaneous recovery within upper motor neuron components of the injury, balanced against the need for expeditious reinnervation for lower motor neuron elements of the injury. The discussion also considers the case of a patient with C6 motor complete SCI where myotomes without electrodiagnostic evidence of denervation spontaneously improved by 6 months post-injury, thereby adjusting the surgical plan. The relevant concepts are integrated into a clinical algorithm with recommendations that consider maximal opportunity for spontaneous clinical improvement post-injury while avoiding excessive delays that may adversely affect patient outcomes.
Collapse
Affiliation(s)
- Valera Castanov
- Queen's University, 4257, School of Medicine, Kingston, Ontario, Canada;
| | - Michael James Berger
- The University of British Columbia, 8166, Division of Physical Medicine and Rehabilitation, Vancouver, British Columbia, Canada.,The University of British Columbia, 8166, International Collaboration on Repair Discoveries, Vancouver, British Columbia, Canada;
| | - Benjamin Ritsma
- Queen's University, 4257, Department of Physical Medicine and Rehabilitation, Kingston, Ontario, Canada.,Providence Care Hospital, 4256, Kingston, Ontario, Canada;
| | - Jessica Trier
- Queen's University, 4257, Department of Physical Medicine and Rehabilitation, Kingston, Ontario, Canada.,Providence Care Hospital, 4256, Kingston, Ontario, Canada;
| | - J Michael Hendry
- Queen's University, 4257, School of Medicine, Kingston, Ontario, Canada.,Queen's University, 4257, Division of Plastic Surgery, Department of Surgery, Kingston, Ontario, Canada.,Kingston Health Sciences Centre, 71459, Kingston, Ontario, Canada;
| |
Collapse
|
33
|
Rosner J, Negraeff M, Bélanger LM, Tsang A, Ritchie L, Mac-Thiong JM, Christie S, Wilson JR, Dhall S, Charest-Morin R, Street J, Ailon T, Paquette S, Dea N, Fisher CG, Dvorak MF, Finnerup NB, Kwon BK, Kramer JLK. Characterization of Hyperacute Neuropathic Pain after Spinal Cord Injury: A Prospective Study. THE JOURNAL OF PAIN 2021; 23:89-97. [PMID: 34302956 DOI: 10.1016/j.jpain.2021.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 06/19/2021] [Accepted: 06/25/2021] [Indexed: 10/20/2022]
Abstract
There is currently a lack of information regarding neuropathic pain in the very early stages of spinal cord injury (SCI). In the present study, neuropathic pain was assessed using the Douleur Neuropathique 4 Questions (DN4) for the patient's worst pain within the first 5 days of injury (i.e., hyperacute) and on follow-up at 3, 6, and 12 months. Within the hyperacute time frame (i.e., 5 days), at- and below-level neuropathic pain were reported as the worst pain in 23% (n = 18) and 5% (n = 4) of individuals with SCI, respectively. Compared to the neuropathic pain observed in this hyperacute setting, late presenting neuropathic pain was characterized by more intense painful electrical and cold sensations, but less itching sensations. Phenotypic differences between acute and late neuropathic pain support the incorporation of timing into a mechanism-based classification of neuropathic pain after SCI. The diagnosis of acute neuropathic pain after SCI is challenged by the presence of nociceptive and neuropathic pains, with the former potentially masking the latter. This may lead to an underestimation of the incidence of neuropathic pain during the very early, hyperacute time points post-injury. TRIAL REGISTRATION: ClinicalTrials.gov (Identifier: NCT01279811) PERSPECTIVE: This article presents distinct pain phenotypes of hyperacute and late presenting neuropathic pain after spinal cord injury and highlights the challenges of pain assessments in the acute phase after injury. This information may be relevant to clinical trial design and broaden our understanding of neuropathic pain mechanisms after spinal cord injury.
Collapse
Affiliation(s)
- Jan Rosner
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada; Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Michael Negraeff
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada; Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Lise M Bélanger
- Vancouver Spine Program, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Angela Tsang
- Vancouver Spine Program, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Leanna Ritchie
- Vancouver Spine Program, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Jean-Marc Mac-Thiong
- Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada; Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - Sean Christie
- Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jefferson R Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ontario, Canada
| | - Sanjay Dhall
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Raphaële Charest-Morin
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - John Street
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada; Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tamir Ailon
- Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott Paquette
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada; Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicolas Dea
- Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles G Fisher
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marcel F Dvorak
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada; Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nanna B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Brian K Kwon
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada; Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - John L K Kramer
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada; Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, British Columbia, Canada.
| |
Collapse
|
34
|
A taxonomy for consistent handling of conditions not related to the spinal cord injury (SCI) in the International Standards for Neurological Classification of SCI (ISNCSCI). Spinal Cord 2021; 60:18-29. [PMID: 34108616 PMCID: PMC8737332 DOI: 10.1038/s41393-021-00646-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 01/26/2023]
Abstract
STUDY DESIGN Committee consensus process including additional structured feedback from spinal cord injury (SCI) experts attending a focus group workshop. OBJECTIVES To define a taxonomy for standardized documentation of non-SCI-related conditions in the International Standards for Neurological Classification of SCI (ISNCSCI). SETTING Americal Spinal Injury Association (ASIA) International Standards Committee with 16 international ISNCSCI experts. METHODS With the new taxonomy, not-normal sensory or motor scores should be tagged with an asterisk ("*"), if they are impacted by a non-SCI condition such as burns, casts, joint contractures, peripheral nerve injuries, amputations, pain, or generalized weakness. The non-SCI condition and instructions on how to handle the "*"-tagged scores during classification should be detailed in the comments box. While sum scores are always calculated based on examined scores, classification variables such as the neurological level of injury (NLI) or the ASIA Impairment Scale (AIS) grades are tagged with an "*", when they have been determined on the basis of clinical assumptions. RESULTS With the extended "*"-tag concept, sensory and motor examination results impacted by non-SCI conditions above, at, or below the NLI can be consistently documented, scored, and classified. Feedback from workshop participants confirms agreement on its clinical relevance, logic and soundness, easiness of understanding, communicability, and applicability in daily work. CONCLUSIONS After multiple internal revisions, a taxonomy for structured documentation of conditions superimposed on the impairments caused by the SCI together with guidelines for consistent scoring and classification was released with the 2019 ISNCSCI revision. This taxonomy is intended to increase the accuracy of ISNCSCI classifications.
Collapse
|
35
|
Kirshblum S, Snider B, Eren F, Guest J. Characterizing Natural Recovery after Traumatic Spinal Cord Injury. J Neurotrauma 2021; 38:1267-1284. [PMID: 33339474 PMCID: PMC8080912 DOI: 10.1089/neu.2020.7473] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The predominant tool used to predict outcomes after traumatic spinal cord injury (SCI) is the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), in association with the American Spinal Injury Association (ASIA) Impairment Scale (AIS). These measures have evolved based on analyses of large amounts of longitudinal neurological recovery data published in numerous separate studies. This article reviews and synthesizes published data on neurological recovery from multiple sources, only utilizing data in which the sacral sparing definition was applied for determination of completeness. Conversion from a complete to incomplete injury is more common in tetraplegia than paraplegia. The majority of AIS conversion and motor recovery occurs within the first 6-9 months, with the most rapid rate of motor recovery occurring in the first three months after injury. Motor score changes, as well as recovery of motor levels, are described with the initial strength of muscles as well as the levels of the motor zone of partial preservation influencing the prognosis. Total motor recovery is greater for patients with initial AIS B than AIS A, and greater after initial AIS C than with motor complete injuries. Older age has a negative impact on neurological and functional recovery after SCI; however, the specific age (whether >50 or >65 years) and underlying reasons for this impact are unclear. Penetrating injury is more likely to lead to a classification of a neurological complete injury compared with blunt trauma and reduces the likelihood of AIS conversion at one year. There are insufficient data to support gender having a major effect on neurological recovery after SCI.
Collapse
Affiliation(s)
- Steven Kirshblum
- Kessler Institute for Rehabilitation, West Orange, New Jersy, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Kessler Foundation, West Orange, New Jersey, USA
| | - Brittany Snider
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Fatma Eren
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Kessler Foundation, West Orange, New Jersey, USA
| | - James Guest
- Neurological Surgery, Miller School of Medicine, Miami, Florida, USA
- The Miami Project to Cure Paralysis, Miami, Florida, USA
| |
Collapse
|
36
|
Round AM, Joo MC, Barakso CM, Fallah N, Noonan VK, Krassioukov AV. Neurogenic Bowel in Acute Rehabilitation Following Spinal Cord Injury: Impact of Laxatives and Opioids. J Clin Med 2021; 10:jcm10081673. [PMID: 33919666 PMCID: PMC8069767 DOI: 10.3390/jcm10081673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/16/2021] [Accepted: 04/10/2021] [Indexed: 12/27/2022] Open
Abstract
Objective: To explore the association between bowel dysfunction and use of laxatives and opioids in an acute rehabilitation setting following spinal cord injury (SCI). Methods: Data was collected regarding individuals with acute traumatic/non-traumatic SCI over a two-year period (2012–2013) during both the week of admission and discharge of their inpatient stay. Results: An increase in frequency of bowel movement (BM) (p = 0.003) and a decrease in frequency of fecal incontinence (FI) per week (p < 0.001) between admission and discharge was found across all participants. There was a reduction in the number of individuals using laxatives (p = 0.004) as well as the number of unique laxatives taken (p < 0.001) between admission and discharge in our cohort. The number of individuals using opioids and the average dose of opioids in morphine milligram equivalents (MME) from admission to discharge were significantly reduced (p = 0.001 and p = 0.02, respectively). There was a positive correlation between the number of laxatives and frequency of FI at discharge (r = 0.194, p = 0.014), suggesting that an increase in laxative use results in an increased frequency of FI. Finally, there was a significant negative correlation between average dose of opioids (MME) and frequency of BM at discharge, confirming the constipating effect of opioids (r = −0.20, p = 0.009).
Collapse
Affiliation(s)
- Andrew M. Round
- International Collaboration on Repair Discoveries (ICORD), Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (A.M.R.); (C.M.B.); (V.K.N.)
- Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada;
- Department of Physical Medicine and Rehabilitation, University of Ottawa, Ottawa, ON K1H 8M2, Canada
| | - Min Cheol Joo
- Department of Rehabilitation Medicine and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan 570-749, Korea;
| | - Carolyn M. Barakso
- International Collaboration on Repair Discoveries (ICORD), Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (A.M.R.); (C.M.B.); (V.K.N.)
| | - Nader Fallah
- Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada;
- Praxis Spinal Cord Institute, Vancouver, BC V5Z 1M9, Canada
| | - Vanessa K. Noonan
- International Collaboration on Repair Discoveries (ICORD), Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (A.M.R.); (C.M.B.); (V.K.N.)
- Praxis Spinal Cord Institute, Vancouver, BC V5Z 1M9, Canada
| | - Andrei V. Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (A.M.R.); (C.M.B.); (V.K.N.)
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC V5Z 2G9, Canada
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC V5Z 2G9, Canada
- Correspondence: ; Tel.: +1-604-675-8819
| |
Collapse
|
37
|
Kawano O, Maeda T, Sakai H, Masuda M, Morishita Y, Hayashi T, Kubota K, Kobayakawa K, Yokota K, Kaneyama H. Significance of the neurological level of injury as a prognostic predictor for motor complete cervical spinal cord injury patients. J Spinal Cord Med 2021; 46:494-500. [PMID: 33830904 PMCID: PMC10116930 DOI: 10.1080/10790268.2021.1903139] [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: 10/21/2022] Open
Abstract
OBJECTIVE To investigate the usefulness of the combination of neurological findings and magnetic resonance imaging (MRI) as a prognostic predictor in patients with motor complete cervical spinal cord injury (CSCI) in the acute phase. DESIGN A cross-sectional analysis. SETTING Department of Orthopaedic Surgery, Spinal Injuries Center. PARTICIPANTS/METHODS Forty-two patients with an initial diagnosis of motor complete CSCI (AIS A, n = 29; AIS B, n = 13) within 72 h after injury were classified into the recovery group (Group R) and the non-recovery group (Group N), based on the presence or absence of motor recovery (conversion from AIS A/B to C/D) at three months after injury, respectively. The Neurological Level of Injury (NLI) at the initial diagnosis was investigated and the presumptive primary injured segment of the spinal cord was inferred from MRI performed at the initial diagnosis. We investigated whether or not the difference between the presumptive primary injured segment and the NLI exceeded one segment. The presence of a difference between the presumptive primary injured segment and the NLI was compared between Groups R and N. RESULTS The number of cases with the differences between the presumptive primary injured segment and the NLI was significantly higher in Group N than in Group R. CONCLUSION The presence of differences between the presumptive primary injured segment and the NLI might be a poor improving prognostic predictor for motor complete CSCI. The NLI may be useful for predicting the recovery potential of patients with motor complete CSCI when combined with the MRI findings.
Collapse
Affiliation(s)
- Osamu Kawano
- Department of Orthopaedic Surgery, Spinal Injuries Center, Fukuoka, Japan
| | - Takeshi Maeda
- Department of Orthopaedic Surgery, Spinal Injuries Center, Fukuoka, Japan
| | - Hiroaki Sakai
- Department of Orthopaedic Surgery, Spinal Injuries Center, Fukuoka, Japan
| | - Muneaki Masuda
- Department of Orthopaedic Surgery, Spinal Injuries Center, Fukuoka, Japan
| | - Yuichiro Morishita
- Department of Orthopaedic Surgery, Spinal Injuries Center, Fukuoka, Japan
| | - Tetsuo Hayashi
- Department of Orthopaedic Surgery, Spinal Injuries Center, Fukuoka, Japan
| | - Kensuke Kubota
- Department of Orthopaedic Surgery, Spinal Injuries Center, Fukuoka, Japan
| | - Kazu Kobayakawa
- Department of Orthopaedic Surgery, Spinal Injuries Center, Fukuoka, Japan
| | - Kazuya Yokota
- Department of Orthopaedic Surgery, Spinal Injuries Center, Fukuoka, Japan
| | - Hironari Kaneyama
- Department of Orthopaedic Surgery, Spinal Injuries Center, Fukuoka, Japan
| |
Collapse
|
38
|
Kim Y, Cho MH, Do K, Kang HJ, Mok JJ, Kim MK, Kim GS. Incidence and risk factors of urinary tract infections in hospitalised patients with spinal cord injury. J Clin Nurs 2021; 30:2068-2078. [PMID: 33829566 DOI: 10.1111/jocn.15763] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/23/2020] [Accepted: 03/10/2021] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To investigate the incidence of urinary tract infection and analyse its risk factors among hospitalised patients with spinal cord injury. BACKGROUND While the incidence of urinary tract infection varies widely according to the healthcare setting and patients' clinical characteristics, formal reports are limited in quantity. There has been no consensus regarding the risk factors for urinary tract infection. DESIGN A retrospective descriptive study. METHODS Electronic medical records of 964 subjects between 2010-2017 were reviewed. Urinary tract infection status was examined to identify newly occurred cases. Data included demographic and clinical characteristics, hydration status and length of hospitalisation. The reporting of the study followed the EQUATOR Network's STROBE checklist. RESULTS Of the sample, 31.7% had urinary tract infection (95% confidence interval: 1.288 to 1.347, p < .001). Sex, completeness of injury, type of bladder emptying, detrusor function and urethral pressure were significant factors affecting urinary tract infection. Patients who were male and those with injury classifications A, B and C had higher risk of urinary tract infection. Patients with urinary or suprapubic indwelling catheters, as well as those with areflexic detrusor combined with normotonic urethral pressure or overactive detrusor combined with normotonic urethral pressure, showed higher risk. Length of hospitalisation in patients with urinary tract infection was greater than that in uninfected patients, which implies the importance of prevention of urinary tract infection. CONCLUSIONS Nurses should carefully assess risk factors to prevent urinary tract infection in patients with spinal cord injury in the acute and sub-acute stages of the disease trajectory and provide individualised nursing care. RELEVANCE TO CLINICAL PRACTICE This study contributes evidence for up-to-date clinical nursing practice for the comprehensive management of urinary tract infection. This can lead to improvements in nursing care quality and patient outcomes, including length of hospitalisation.
Collapse
Affiliation(s)
- Yielin Kim
- Division of Nursing, Severance Hospital, Yonsei University Health System, Seoul, South Korea.,Graduate School, College of Nursing, Yonsei University, Seoul, South Korea
| | - Mi Hwa Cho
- Division of Nursing, Severance Hospital, Yonsei University Health System, Seoul, South Korea
| | - Kyungmin Do
- Division of Nursing, Severance Hospital, Yonsei University Health System, Seoul, South Korea
| | - Hye Jin Kang
- Division of Nursing, Severance Hospital, Yonsei University Health System, Seoul, South Korea
| | - Jin Ju Mok
- Division of Nursing, Severance Hospital, Yonsei University Health System, Seoul, South Korea
| | - Mi Kyoung Kim
- Division of Nursing, Severance Hospital, Yonsei University Health System, Seoul, South Korea
| | - Gwang Suk Kim
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
| |
Collapse
|
39
|
Buri M, Tanadini LG, Hothorn T, Curt A. Unbiased Recursive Partitioning Enables Robust and Reliable Outcome Prediction in Acute Spinal Cord Injury. J Neurotrauma 2021; 39:266-276. [PMID: 33619988 DOI: 10.1089/neu.2020.7407] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Neurological disorders usually present very heterogeneous recovery patterns. Nonetheless, accurate prediction of future clinical end-points and robust definition of homogeneous cohorts are necessary for scientific investigation and targeted care. For this, unbiased recursive partitioning with conditional inference trees (URP-CTREE) have received increasing attention in medical research, especially, but not limited to traumatic spinal cord injuries (SCIs). URP-CTREE was introduced to SCI as a clinical guidance tool to explore and define homogeneous outcome groups by clinical means, while providing high accuracy in predicting future clinical outcomes. The validity and predictive value of URP-CTREE to provide improvements compared with other more common approaches applied by clinicians has recently come under critical scrutiny. Therefore, a comprehensive simulation study based on traumatic, cervical complete spinal cord injuries provides a framework to investigate and quantify the issues raised. First, we assessed the replicability and robustness of URP-CTREE to identify homogeneous subgroups. Second, we implemented a prediction performance comparison of URP-CTREE with traditional statistical techniques, such as linear or logistic regression, and a novel machine learning method. URP-CTREE's ability to identify homogeneous subgroups proved to be replicable and robust. In terms of prediction, URP-CTREE yielded a high prognostic performance comparable to a machine learning algorithm. The simulation study provides strong evidence for the robustness of URP-CTREE, which is achieved without compromising prediction accuracy. The slightly lower prediction performance is offset by URP-CTREE's straightforward interpretation and application in clinical settings based on simple, data-driven decision rules.
Collapse
Affiliation(s)
- Muriel Buri
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zürich, Switzerland
| | - Lorenzo G Tanadini
- School of Agricultural, Forest and Food Sciences, Bern University of Applied Sciences, Bern, Switzerland
| | - Torsten Hothorn
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zürich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zürich, Switzerland
| |
Collapse
|
40
|
Aschauer-Wallner S, Leis S, Bogdahn U, Johannesen S, Couillard-Despres S, Aigner L. Granulocyte colony-stimulating factor in traumatic spinal cord injury. Drug Discov Today 2021; 26:1642-1655. [PMID: 33781952 DOI: 10.1016/j.drudis.2021.03.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/23/2021] [Accepted: 03/17/2021] [Indexed: 12/12/2022]
Abstract
Granulocyte colony-stimulating factor (G-CSF) is a cytokine used in pharmaceutical preparations for the treatment of chemotherapy-induced neutropenia. Evidence from experimental studies indicates that G-CSF exerts relevant activities in the central nervous system (CNS) in particular after lesions. In acute, subacute, and chronic CNS lesions, G-CSF appears to have strong anti-inflammatory, antiapoptotic, antioxidative, myelin-protective, and axon-regenerative activities. Additional effects result in the stimulation of angiogenesis and neurogenesis as well as in bone marrow stem cell mobilization to the CNS. There are emerging preclinical and clinical data indicating that G-CSF is a safe and effective drug for the treatment of acute and chronic traumatic spinal cord injury (tSCI), which we summarize in this review.
Collapse
Affiliation(s)
- Stephanie Aschauer-Wallner
- Department of Orthopedics and Traumatology, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria.
| | - Stefan Leis
- Department of Neurology, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Ulrich Bogdahn
- Velvio GmbH, Regensburg, Germany; Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Siw Johannesen
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany; Department of Neurology, BG Trauma Center Murnau, Murnau, Germany
| | - Sebastien Couillard-Despres
- Institute of Experimental Neuroregeneration, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Ludwig Aigner
- Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| |
Collapse
|
41
|
Boudreau E, Otamendi A, Levine J, Griffin JF, Gilmour L, Jeffery N. Relationship between Machine-Learning Image Classification of T 2-Weighted Intramedullary Hypointensity on 3 Tesla Magnetic Resonance Imaging and Clinical Outcome in Dogs with Severe Spinal Cord Injury. J Neurotrauma 2020; 38:725-733. [PMID: 33054592 DOI: 10.1089/neu.2020.7188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Early prognostic information in cases of severe spinal cord injury can aid treatment planning and stratification for clinical trials. Analysis of intraparenchymal signal change on magnetic resonance imaging has been suggested to inform outcome prediction in traumatic spinal cord injury. We hypothesized that intraparenchymal T2-weighted hypointensity would be associated with a lower potential for functional recovery and a higher risk of progressive neurological deterioration in dogs with acute, severe, naturally occurring spinal cord injury. Our objectives were to: 1) demonstrate capacity for machine-learning criteria to identify clinically relevant regions of hypointensity and 2) compare clinical outcomes for cases with and without such regions. A total of 95 dogs with complete spinal cord injury were evaluated. An image classification system, based on Speeded-Up Robust Features (SURF), was trained to recognize individual axial T2-weighted slices that contained hypointensity. The presence of such slices in a given transverse series was correlated with a lower chance of functional recovery (odds ratio [OR], 0.08; confidence interval [CI], 0.02-0.38; p < 10-3) and with a higher risk of neurological deterioration (OR, 0.14; 95% CI, 0.05-0.42; p < 10-3). Identification of intraparenchymal T2-weighted hypointensity in severe, naturally occurring spinal cord injury may be assisted by an image classification tool and is correlated with functional recovery.
Collapse
Affiliation(s)
- Elizabeth Boudreau
- Texas A&M University College of Veterinary Medicine and Biomedical Sciences, College Station, Texas, USA
| | - Arturo Otamendi
- VCA San Francisco Veterinary Specialists, San Francisco, California, USA
| | - Jonathan Levine
- Texas A&M University College of Veterinary Medicine and Biomedical Sciences, College Station, Texas, USA
| | - John F Griffin
- Texas A&M University College of Veterinary Medicine and Biomedical Sciences, College Station, Texas, USA
| | - Lindsey Gilmour
- Texas A&M University College of Veterinary Medicine and Biomedical Sciences, College Station, Texas, USA
| | - Nicholas Jeffery
- Texas A&M University College of Veterinary Medicine and Biomedical Sciences, College Station, Texas, USA
| |
Collapse
|
42
|
Bazarek S, Brown JM. The evolution of nerve transfers for spinal cord injury. Exp Neurol 2020; 333:113426. [DOI: 10.1016/j.expneurol.2020.113426] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 07/10/2020] [Accepted: 07/25/2020] [Indexed: 12/15/2022]
|
43
|
Lucci VEM, Inskip JA, McGrath MS, Ruiz I, Lee R, Kwon BK, Claydon VE. Longitudinal Assessment of Autonomic Function during the Acute Phase of Spinal Cord Injury: Use of Low-Frequency Blood Pressure Variability as a Quantitative Measure of Autonomic Function. J Neurotrauma 2020; 38:309-321. [PMID: 32940126 DOI: 10.1089/neu.2020.7286] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
High-level spinal cord injury (SCI) can disrupt cardiovascular autonomic function. However, the evolution of cardiovascular autonomic function in the acute phase following injury is unknown. We evaluated the timing, severity, progression, and implications of cardiovascular autonomic injury following acute SCI. We tested 63 individuals with acute traumatic SCI (aged 48 ± 2 years) at five time-points: <2 weeks, and 1, 3, 6-12, and >12 months post-injury. Supine beat-to-beat systolic arterial pressure (SAP) and R-R interval (RRI) were recorded and low-frequency variability (LF SAP and LF RRI) determined. Cross-spectral analyses were used to determine baroreflex function (low frequency) and cardiorespiratory interactions (high frequency). Known electrocardiographic (ECG) markers for arrhythmia and self-reported symptoms of cardiovascular dysfunction were determined. Comparisons were made with historical data from individuals with chronic SCI and able-bodied controls. Most individuals had high-level (74%) motor/sensory incomplete (63%) lesions. All participants had decreased LF SAP at <2 weeks (2.22 ± 0.65 mm Hg2). Autonomic injury was defined as high-level SCI with LF SAP <2 mm Hg2. Two distinct groups emerged by 1 month: autonomically complete SCI with sustained low LF SAP (0.76 ± 0.17 mm Hg2) and autonomically incomplete SCI with increased LF SAP (5.46 ± 1.0 mm Hg2, p < 0.05). Autonomically complete injuries did not recover over time. Cardiovascular symptoms were prevalent and worsened with time, especially in those with autonomically complete lesions, and chronic SCI. Baroreflex function and cardiorespiratory interactions were impaired after SCI. Risk of arrhythmia increased immediately after SCI, and remained elevated throughout the acute phase. Acute SCI is associated with severe cardiovascular dysfunction. LF SAP provides a simple, non-invasive, translatable, quantitative assessment of autonomic function, and is most informative 1 month after injury.
Collapse
Affiliation(s)
- Vera-Ellen M Lucci
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada.,International Collaboration on Repair and Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessica A Inskip
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada.,International Collaboration on Repair and Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Maureen S McGrath
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada.,International Collaboration on Repair and Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Ian Ruiz
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Rebekah Lee
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Brian K Kwon
- International Collaboration on Repair and Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada.,Department of Orthopedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Victoria E Claydon
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada.,International Collaboration on Repair and Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
44
|
Yoo J. Evaluation and prognosis of spinal cord injury. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2020. [DOI: 10.5124/jkma.2020.63.10.596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
It is important to perform an accurate neurological assessment using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) to judge the prognosis of spinal cord injury patients. We can gauge the prognosis for upper extremity function or gait ability according to the ISNCSCI results. ISNCSCI involves both sensory and motor examination, and it is performed with the patient in the supine position to enable a comparison between the initial and follow-up exams. The sensory exam is performed on the 28 key sensory points of dermatomes for light touch and pinprick. The motor exam is performed on 10 key muscles on each side. The sensory and motor levels for the right and left sides are determined according to the sensory and motor exam results. The neurological level of injury is the most caudal level of the cord at which both the motor and sensory functions are intact. Finally, the American Spinal Injury Association Impairment Scale (AIS) is determined. AIS A indicates complete injury, and AIS B, C, and D indicate incomplete injuries. Once the sensory and motor levels, neurological level of injury, and AIS scale of a spinal cord injury patient are determined through ISNCSCI, the patient's prognosis can be predicted based on those results. Furthermore, ISNCSCI performed at 72 hours after an injury yields the most significant prognostic factors.
Collapse
|
45
|
Kirshblum S, Botticello A, Benedetto J, Donovan J, Marino R, Hsieh S, Wagaman N. A Comparison of Diagnostic Stability of the ASIA Impairment Scale Versus Frankel Classification Systems for Traumatic Spinal Cord Injury. Arch Phys Med Rehabil 2020; 101:1556-1562. [DOI: 10.1016/j.apmr.2020.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/20/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
|
46
|
|
47
|
Olby N, Griffith E, Levine J. Comparison of Gait Assessment Scales in Dogs with Spinal Cord Injury from Intervertebral Disc Herniation. J Neurotrauma 2020; 37:1991-1998. [PMID: 31914849 DOI: 10.1089/neu.2019.6804] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Naturally occurring thoracolumbar spinal cord injury (SCI) is common in dogs, and multi-center veterinary clinical studies can serve as translational tools to identify potentially effective therapies for human clinical trials. Assessment of gait is a key outcome, and several scales are used in dogs. The purpose of this study was to determine whether an international group of researchers could score gait reliably, to compare and contrast the performance of gait scales and to describe appropriate data analysis techniques. A training module was developed for a binary scale, modified Frankel Scale (MFS), Texas SCI Scale (TSCIS), and Open Field Scale (OFS). Raters viewed the training module, scored five training video clips to achieve proficiency, then scored 30 video clips from 10 dogs recovering from SCI. Interrater reliability was calculated, and correlation between scales was examined. Ceiling effect was described. Twenty raters with differing experience participated. The training module took 16 min to view. Raters chose identical binary outcomes in 597 of 600 observations. Intraclass correlation for MFS, TSCIS, and OFS was excellent at 0.85, 0.96, and 0.96, respectively, regardless of rater expertise. Ceiling effect occurred in all dogs that recovered ambulation, particularly using MFS and binary outcome. The TSCIS and OFS captured recovery of ambulatory dogs better, and addition of scores on hopping and proprioception mitigated ceiling effect. We conclude that gait in dogs with SCI can be scored reliably after training. A variety of different gait scales can be used in multi-center trials to capture outcome in different ways.
Collapse
Affiliation(s)
- Natasha Olby
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina, USA.,The Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
| | - Emily Griffith
- Department of Statistics, North Carolina State University College of Sciences, Raleigh, North Carolina, USA
| | - Jon Levine
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, College Station, Texas, USA
| | | |
Collapse
|
48
|
Bartlett RD, Burley S, Ip M, Phillips JB, Choi D. Cell Therapies for Spinal Cord Injury: Trends and Challenges of Current Clinical Trials. Neurosurgery 2020; 87:E456-E472. [DOI: 10.1093/neuros/nyaa149] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 03/11/2020] [Indexed: 12/22/2022] Open
Abstract
Abstract
Cell therapies have the potential to revolutionize the treatment of spinal cord injury. Basic research has progressed significantly in recent years, with a plethora of cell types now reaching early-phase human clinical trials, offering new strategies to repair the spinal cord. However, despite initial enthusiasm for preclinical and early-phase clinical trials, there has been a notable hiatus in the translation of cell therapies to routine clinical practice. Here, we review cell therapies that have reached clinical trials for spinal cord injury, providing a snapshot of all registered human trials and a summary of all published studies. Of registered trials, the majority have used autologous cells and approximately a third have been government funded, a third industry sponsored, and a third funded by university or healthcare systems. A total of 37 cell therapy trials have been published, primarily using stem cells, although a smaller number have used Schwann cells or olfactory ensheathing cells. Significant challenges remain for cell therapy trials in this area, including achieving stringent regulatory standards, ensuring appropriately powered efficacy trials, and establishing sustainable long-term funding. However, cell therapies hold great promise for human spinal cord repair and future trials must continue to capitalize on the exciting developments emerging from preclinical studies.
Collapse
Affiliation(s)
- Richard D Bartlett
- Centre for Nerve Engineering, University College London, London, United Kingdom
- Department of Pharmacology, UCL School of Pharmacy, University College London, London, United Kingdom
- Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, United Kingdom
| | - Sarah Burley
- Centre for Nerve Engineering, University College London, London, United Kingdom
| | - Mina Ip
- Centre for Nerve Engineering, University College London, London, United Kingdom
| | - James B Phillips
- Centre for Nerve Engineering, University College London, London, United Kingdom
- Department of Pharmacology, UCL School of Pharmacy, University College London, London, United Kingdom
| | - David Choi
- Centre for Nerve Engineering, University College London, London, United Kingdom
- Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, United Kingdom
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| |
Collapse
|
49
|
Buri M, Curt A, Steeves J, Hothorn T. Baseline-adjusted proportional odds models for the quantification of treatment effects in trials with ordinal sum score outcomes. BMC Med Res Methodol 2020; 20:104. [PMID: 32375705 PMCID: PMC7204322 DOI: 10.1186/s12874-020-00984-2] [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: 03/20/2019] [Accepted: 04/20/2020] [Indexed: 11/10/2022] Open
Abstract
Background Sum scores of ordinal outcomes are common in randomized clinical trials. The approaches routinely employed for assessing treatment effects, such as t-tests or Wilcoxon tests, are not particularly powerful in detecting changes in relevant parameters or lack the ability to incorporate baseline information. Hence, tailored statistical methods are needed for the analysis of ordinal outcomes in clinical research. Methods We propose baseline-adjusted proportional odds logistic regression models to overcome previous limitations in the analysis of ordinal outcomes in randomized clinical trials. For the validation of our method, we focus on common ordinal sum score outcomes of neurological clinical trials such as the upper extremity motor score, the spinal cord independence measure, and the self-care subscore of the latter. We compare the statistical power of our models to other conventional approaches in a large simulation study of two-arm randomized clinical trials based on data from the European Multicenter Study about Spinal Cord Injury (EMSCI, ClinicalTrials.gov Identifier: NCT01571531). We also use the new method as an alternative analysis of the historical Sygen®clinical trial. Results The simulation study of all postulated trial settings demonstrated that the statistical power of the novel method was greater than that of conventional methods. Baseline adjustments were more suited for the analysis of the upper extremity motor score compared to the spinal cord independence measure and its self-care subscore. Conclusions The proposed baseline-adjusted proportional odds models allow the global treatment effect to be directly interpreted. This clear interpretation, the superior statistical power compared to the conventional analysis approaches, and the availability of open-source software support the application of this novel method for the analysis of ordinal outcomes of future clinical trials.
Collapse
Affiliation(s)
- Muriel Buri
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, Zurich, CH-8001, Switzerland
| | - Armin Curt
- University Hospital Balgrist, Spinal Cord Injury Center, Forchstrasse 340, Zurich, CH-8008, Switzerland
| | - John Steeves
- International Collaboration On Repair Discoveries (ICORD), University of British Columbia, Vancouver/Kelowna, Canada
| | - Torsten Hothorn
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, Zurich, CH-8001, Switzerland.
| |
Collapse
|
50
|
Holland SD. Journal Club: Width and neurophysiologic properties of tissue bridges predict recovery after cervical injury. Neurology 2020; 94:e1961-e1963. [DOI: 10.1212/wnl.0000000000008941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|