1
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Schuld C, Kirshblum S, Tansey K, Rupp R. The revised zone of partial preservation (ZPP) in the 2019 International Standards for Neurological Classification of Spinal Cord Injury: ZPP applicability in incomplete injuries. Spinal Cord 2024; 62:79-87. [PMID: 38191920 PMCID: PMC10853064 DOI: 10.1038/s41393-023-00950-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 11/17/2023] [Accepted: 12/13/2023] [Indexed: 01/10/2024]
Abstract
STUDY DESIGN Consensus process. OBJECTIVES To provide a reference for the Zone(s) of Partial Preservation (ZPP) in the 2019 International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and analyze the initial impact of applicability of the revised ZPPs. Revisions include the use of ZPPs in selected incomplete injuries (in addition to prior use in sensorimotor complete injuries). Specifically, the revised motor ZPPs are applicable bilaterally in injuries with absent voluntary anal contraction (VAC) and the revised sensory ZPP for a given side is applicable if deep anal pressure (DAP), light touch and pin prick sensation in S4-5 are absent on that side. SETTING Committee with 16 ISNCSCI experts and datasets from the European Multicenter Study about Spinal Cord Injury (EMSCI). METHODS Occurrence frequencies of applicable ZPPs were determined in an EMSCI cohort consisting of two ISNCSCI examinations from 665 individuals with traumatic SCI. RESULTS Motor ZPPs were derived in 35.2% of all datasets of incomplete injuries, while sensory ZPPs are much less frequent (1.0%). Motor ZPPs are applicable in all American Spinal Injury Association Impairment Scale (AIS) B datasets (mean ZPP length: 0.9 ± 1.0 segments), in 55.4% of all AIS C datasets (ZPP length: 11.8 ± 8.2 segments) and in 9.9% of the AIS D datasets (ZPP length: 15.4 ± 7.9 segments). CONCLUSIONS The revised ZPP allows for determining motor ZPPs in approximately 1/3 of all incomplete injuries. The broadened applicability enables the use of ZPPs beyond complete injuries for complementary description of residual functions in more individuals. SPONSORSHIP N/A.
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Affiliation(s)
- Christian Schuld
- Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany
| | - Steven Kirshblum
- Kessler Institute for Rehabilitation, West Orange, NJ, USA
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Keith Tansey
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, MS, USA
- Spinal Cord Injury Clinic, Jackson VA Medical Center, Jackson, MS, USA
- Departments of Neurosurgery and Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, MS, USA
| | - Rüdiger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118, Heidelberg, Germany.
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Kelly-Hedrik M, Abd-El-Barr MM, Aarabi B, Curt A, Howley SP, Harrop JS, Kirshblum S, Neal CJ, Noonan V, Park C, Ugiliweneza B, Tator C, Toups EG, Fehlings MG, Williamson T, Guest JD. Importance of Prospective Registries and Clinical Research Networks in the Evolution of Spinal Cord Injury Care. J Neurotrauma 2023; 40:1834-1848. [PMID: 36576020 DOI: 10.1089/neu.2022.0450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Only 100 years ago, traumatic spinal cord injury (SCI) was commonly lethal. Today, most people who sustain SCI survive with continual efforts to improve their quality of life and neurological outcomes. SCI epidemiology is changing as preventative interventions reduce injuries in younger individuals, and there is an increased incidence of incomplete injuries in aging populations. Early treatment has become more intensive with decompressive surgery and proactive interventions to improve spinal cord perfusion. Accurate data, including specialized outcome measures, are crucial to understanding the impact of epidemiological and treatment trends. Dedicated SCI clinical research and data networks and registries have been established in the United States, Canada, Europe, and several other countries. We review four registry networks: the North American Clinical Trials Network (NACTN) SCI Registry, the National Spinal Cord Injury Model Systems (SCIMS) Database, the Rick Hansen SCI Registry (RHSCIR), and the European Multi-Center Study about Spinal Cord Injury (EMSCI). We compare the registries' focuses, data platforms, advanced analytics use, and impacts. We also describe how registries' data can be combined with electronic health records (EHRs) or shared using federated analysis to protect registrants' identities. These registries have identified changes in epidemiology, recovery patterns, complication incidence, and the impact of practice changes such as early decompression. They've also revealed latent disease-modifying factors, helped develop clinical trial stratification models, and served as matched control groups in clinical trials. Advancing SCI clinical science for personalized medicine requires advanced analytical techniques, including machine learning, counterfactual analysis, and the creation of digital twins. Registries and other data sources help drive innovation in SCI clinical science.
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Affiliation(s)
| | | | - Bizhan Aarabi
- University of Maryland School of Medicine, Maryland, USA
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Susan P Howley
- Christopher & Dana Reeve Foundation, Short Hills, New Jersey, USA
| | - James S Harrop
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Steven Kirshblum
- Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Kessler Institute for Rehabilitation, West Orange, New Jersey, USA
- Kessler Foundation, West Orange, New Jersey, USA
| | - Christopher J Neal
- Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Vanessa Noonan
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | - Christine Park
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Charles Tator
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth G Toups
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Michael G Fehlings
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Theresa Williamson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James D Guest
- Neurological Surgery and The Miami Project to Cure Paralysis, University of Miami, Miami, USA
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3
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Zhang H, Wu C, Yu DD, Su H, Chen Y, Ni W. Piperine attenuates the inflammation, oxidative stress, and pyroptosis to facilitate recovery from spinal cord injury via autophagy enhancement. Phytother Res 2023; 37:438-451. [PMID: 36114802 DOI: 10.1002/ptr.7625] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/26/2022] [Accepted: 09/02/2022] [Indexed: 11/08/2022]
Abstract
Spinal cord injury (SCI) is a serious injury that can lead to irreversible motor dysfunction. Due to its complicated pathogenic mechanism, there are no effective drug treatments. Piperine, a natural active alkaloid extracted from black pepper, has been reported to influence neurogenesis and exert a neuroprotective effect in traumatic brain injury. The aim of this study was to investigate the therapeutic effect of piperine in an SCI model. SCI was induced in mice by clamping the spinal cord with a vascular clip for 1 min. Before SCI and every 2 days post-SCI, evaluations using the Basso mouse scale and inclined plane tests were performed. On day 28 after SCI, footprint analyses, and HE/Masson staining of tissues were performed. On a postoperative Day 3, the spinal cord was harvested to assess the levels of pyroptosis, reactive oxygen species (ROS), inflammation, and autophagy. Piperine enhanced functional recovery after SCI. Additionally, piperine reduced inflammation, oxidative stress, pyroptosis, and activated autophagy. However, the effects of piperine on functional recovery after SCI were reversed by autophagy inhibition. The study demonstrated that piperine facilitated functional recovery after SCI by inhibiting inflammatory, oxidative stress, and pyroptosis, mediated by the activation of autophagy.
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Affiliation(s)
- Haojie Zhang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, People's Republic of China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Chenyu Wu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, People's Republic of China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Dong-Dong Yu
- Department of Urology, Huzhou Central Hospital, Huzhou, People's Republic of China
| | - Haohan Su
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, People's Republic of China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Yanlin Chen
- Spinal Surgery Department, The Central Hospital of Lishui City, Lishui, People's Republic of China
| | - Wenfei Ni
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, People's Republic of China.,Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou Medical University, Wenzhou, People's Republic of China
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4
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Computer International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) algorithms: a review. Spinal Cord 2023; 61:125-132. [PMID: 36114239 PMCID: PMC9970871 DOI: 10.1038/s41393-022-00854-2] [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: 09/20/2021] [Revised: 08/16/2022] [Accepted: 08/29/2022] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Literature review and survey. OBJECTIVES To provide an overview of existing computerized International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) algorithms and to evaluate the use of the current algorithms in research and clinical care. SETTING Not applicable. METHODS Literature review according to three organizing concepts for evaluation of Health Information Products (reach, usefulness, and use) was conducted. RESULTS While the use of computerized ISNCSCI algorithms has been around for many years, many were developed and used internally for specific projects or not maintained. Today the International SCI community has free access to algorithms from the European Multicenter Study about Spinal Cord Injury (EMSCI) and the Praxis Spinal Cord Institute. Both algorithms have been validated in large datasets and are used in different SCI registries for quality control and education purposes. The use of the Praxis Institute algorithm by clinicians was highlighted through the Praxis User Survey (n = 76) which included participants from 27 countries. The survey found that over half of the participants using the algorithm (N = 69) did so on a regular basis (51%), with 54% having incorporated it into their regular workflow. CONCLUSIONS Validated computerized ISNCSCI classification tools have evolved substantially and support education, clinical documentation, communication between clinicians and their patients, and ISNCSCI data quality around the world. They are not intended to replace well-trained clinicians, but allow for reclassification of ISNCSCI datasets with updated versions of the ISCNSCI, and support rapid classification of large datasets.
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5
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Bourguignon L, Tong B, Geisler F, Schubert M, Röhrich F, Saur M, Weidner N, Rupp R, Kalke YBB, Abel R, Maier D, Grassner L, Chhabra HS, Liebscher T, Cragg JJ, Kramer J, Curt A, Jutzeler CR. International surveillance study in acute spinal cord injury confirms viability of multinational clinical trials. BMC Med 2022; 20:225. [PMID: 35705947 PMCID: PMC9202190 DOI: 10.1186/s12916-022-02395-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/04/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The epidemiological international landscape of traumatic spinal cord injury (SCI) has evolved over the last decades along with given inherent differences in acute care and rehabilitation across countries and jurisdictions. However, to what extent these differences may influence neurological and functional recovery as well as the integrity of international trials is unclear. The latter also relates to historical clinical data that are exploited to inform clinical trial design and as potential comparative data. METHODS Epidemiological and clinical data of individuals with traumatic and ischemic SCI enrolled in the European Multi-Center Study about Spinal Cord Injury (EMSCI) were analyzed. Mixed-effect models were employed to account for the longitudinal nature of the data, efficiently handle missing data, and adjust for covariates. The primary outcomes comprised demographics/injury characteristics and standard scores to quantify neurological (i.e., motor and sensory scores examined according to the International Standards for the Neurological Classification of Spinal Cord Injury) and functional recovery (walking function). We externally validated our findings leveraging data from a completed North American landmark clinical trial. RESULTS A total of 4601 patients with acute SCI were included. Over the course of 20 years, the ratio of male to female patients remained stable at 3:1, while the distribution of age at injury significantly shifted from unimodal (2001/02) to bimodal distribution (2019). The proportional distribution of injury severities and levels remained stable with the largest percentages of motor complete injuries. Both, the rate and pattern of neurological and functional recovery, remained unchanged throughout the surveillance period despite the increasing age at injury. The findings related to recovery profiles were confirmed by an external validation cohort (n=791). Lastly, we built an open-access and online surveillance platform ("Neurosurveillance") to interactively exploit the study results and beyond. CONCLUSIONS Despite some epidemiological changes and considerable advances in clinical management and rehabilitation, the neurological and functional recovery following SCI has remained stable over the last two decades. Our study, including a newly created open-access and online surveillance tool, constitutes an unparalleled resource to inform clinical practice and implementation of forthcoming clinical trials targeting neural repair and plasticity in acute spinal cord injury.
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Affiliation(s)
- Lucie Bourguignon
- Department of Health Sciences and Technology (D-HEST), ETH Zurich, Zürich, Switzerland.,SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Bobo Tong
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
| | - Fred Geisler
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Martin Schubert
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Lengghalde 2, 8006, Zürich, Switzerland
| | - Frank Röhrich
- Berufsgenossenschaftliche Klinik Bergmanstrost of Halle, Halle, Germany
| | - Marion Saur
- Orthopädische Klinik, Hessisch Lichtenau, Germany
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Rüdiger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Rainer Abel
- Spinal Cord Injury Center, Bayreuth, Germany
| | - Doris Maier
- Spinal Cord Injury Center, Trauma Center Murnau, Murnau, Germany
| | - Lukas Grassner
- Spinal Cord Injury Center, Trauma Center Murnau, Murnau, Germany.,Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Harvinder S Chhabra
- Spine Service, Indian Spinal Injuries Centre, Sector C, Vasant Kunj, New Delhi, India
| | - Thomas Liebscher
- Treatment Centre for Spinal Cord Injuries, Trauma Hospital Berlin, Berlin, Germany
| | - Jacquelyn J Cragg
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada.,Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | | | - John 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
| | - Armin Curt
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Lengghalde 2, 8006, Zürich, Switzerland
| | - Catherine R Jutzeler
- Department of Health Sciences and Technology (D-HEST), ETH Zurich, Zürich, Switzerland. .,SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland. .,Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Lengghalde 2, 8006, Zürich, Switzerland.
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6
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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.
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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;
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Implementation of multilingual support of the European Multicenter Study about Spinal Cord Injury (EMSCI) ISNCSCI calculator. Spinal Cord 2021; 60:37-44. [PMID: 34404913 PMCID: PMC8737334 DOI: 10.1038/s41393-021-00672-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 11/25/2022]
Abstract
Objectives Since their introduction, electronic International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) calculators have evolved to powerful tools providing error-free ISNCSCI classifications in education, research and clinical practice. For increased accessibility and dissemination, a multilingual support is mandatory. The aim of this work was to setup a general multilingual framework for the freely available ISNCSCI calculator (https://ais.emsci.org) of the European Multicenter Study about Spinal Cord Injury (EMSCI). Methods The graphical user interface (GUI) and PDF export of the ISNCSCI worksheet were adapted for multilingual implementations. Their language-dependent content was identified. These two steps called internationalization have to be performed by a programmer in preparation of the translations of the English terms into the target language. This step following the internationalization is called localization and needs input by a bi-lingual clinical expert. Two EMSCI partners provided Standard Mandarin Chinese and Czech translations. Finally, the translations are made available in the application. Results The GUI and PDF export of the ISNCSCI worksheet were internationalized. The default language of the calculator is set according to the user’s preferences with the additional possibility for manual language selection. The Chinese as well as a Czech translation were provided freely to the SCI community. Conclusions The possibility of multilingual implementations independent from software developers opens the use of ISNCSCI computer algorithms as an efficient training tool on a larger scale.
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8
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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.
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9
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Rupp R, Biering-Sørensen F, Burns SP, Graves DE, Guest J, Jones L, Read MS, Rodriguez GM, Schuld C, Tansey-Md KE, Walden K, Kirshblum S. International Standards for Neurological Classification of Spinal Cord Injury: Revised 2019. Top Spinal Cord Inj Rehabil 2021; 27:1-22. [PMID: 34108832 DOI: 10.46292/sci2702-1] [Citation(s) in RCA: 131] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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10
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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: 104] [Impact Index Per Article: 34.7] [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.
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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
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11
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Prang P, Schuld C, Rupp R, Hensel C, Weidner N. Influence of patient isolation due to colonization with multidrug-resistant organisms on functional recovery after spinal cord injury. PLoS One 2021; 16:e0249295. [PMID: 33770131 PMCID: PMC7997009 DOI: 10.1371/journal.pone.0249295] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 03/16/2021] [Indexed: 11/19/2022] Open
Abstract
STUDY DESIGN Chart reviews were combined with neurological and functional outcome data obtained from the prospective European Multicenter Study on Spinal Cord Injury (EMSCI, www.emsci.org). OBJECTIVES To determine if strict physical isolation of multidrug-resistant organisms (MDRO)-positive patients negatively affects neurological recovery and functional outcome in the first year after acute spinal cord injury (SCI). SETTING SCI Center Heidelberg University Hospital. METHODS Individuals with acute (< 6 weeks) traumatic or ischemic SCI were included. During primary comprehensive care, isolated MDRO-positive patients (n = 13) were compared with a MDRO-negative control group (n = 13) matched for functional (Spinal Cord Independence Measure-SCIM) and neurological impairment (motor scores based on the International Standards for Neurological Classification of Spinal Cord Injury-ISNCSCI) at an early stage up to 40 days after SCI. SCIM scores and motor scores were obtained at 12 weeks (intermediate stage) and 24 or 48 weeks (late stage) after SCI. RESULTS Isolated MDRO-positive (median duration of hospitalization: 175 days, 39% of inpatient stay under isolation measures) and non-isolated MDRO-negative (median duration of hospitalization: 161 days) patients showed functional and neurological improvements, which were not statistically different between groups at the intermediate and late stage. CONCLUSION Prolonged isolation due to MDRO colonization for over a third of the inpatient comprehensive care period does not appear to impair neurological recovery and functional outcome within the first year after SCI.
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Affiliation(s)
- Peter Prang
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Schuld
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Ruediger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Cornelia Hensel
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
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12
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Franz S, Heutehaus L, Weinand S, Weidner N, Rupp R, Schuld C. Theoretical and practical training improves knowledge of the examination guidelines of the International Standards for Neurological Classification of Spinal Cord Injury. Spinal Cord 2020; 60:1-10. [PMID: 33204033 PMCID: PMC8737333 DOI: 10.1038/s41393-020-00578-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 11/29/2022]
Abstract
Study design Prospective pre–post study. Objectives International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) represents the most frequently used assessment to determine the level and severity of a spinal cord injury (SCI). The guidelines for ISNCSCI are complex and challenging. Knowledge of its correct execution needs to be imparted precisely. The aim of this study was to investigate whether hands-on instructional courses can increase the knowledge of the ISNCSCI examination guidelines. Setting European Multicenter Study about SCI. Methods Before and after the instructional courses, participants were asked to complete questionnaires. The set of questions covered the most important aspects of the examination guidelines. Attendees were asked to self-rate their occupation and experience in ISNCSCI. Results The comparison of pretest and posttest results of 164 attendees from 2014 to 2018 revealed an improvement of knowledge reflected by an increase of correct answers from 66 ± 17% before to 89 ± 11% after the course (p < 0.01). The improvement was not associated with occupation (p > 0.1). However, the correctness of pretest results differed concerning both the period of experience with ISNCSCI (p < 0.05) and the course language (p < 0.01), while the frequency of execution resulted in differences in the posttest (p = 0.01). Conclusions Instructional courses substantially improve knowledge of the ISNCSCI examination guidelines. Differences in knowledge present before the course leveled off after the course. Comprehensive theoretical training is strongly recommended to ensure reliability and validity of ISNCSCI examinations in clinical routine and research. Albeit being practiced in the instructional courses, the benefit of hands-on training still needs to be systematically evaluated in future studies.
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Affiliation(s)
- Steffen Franz
- Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany.
| | - Laura Heutehaus
- Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - Sina Weinand
- Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - Rüdiger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - Christian Schuld
- Spinal Cord Injury Center, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
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13
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Scivoletto G, Torre M, Mammone A, Maier DD, Weidner N, Schubert M, Rupp R, Abel R, Yorck-Bernhard K, Jiri K, Curt A, Molinari M. Acute Traumatic and Ischemic Spinal Cord Injuries Have a Comparable Course of Recovery. Neurorehabil Neural Repair 2020; 34:723-732. [DOI: 10.1177/1545968320939569] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background. The relative rarity of ischemic compared with traumatic spinal cord injury (SCI) has limited a comparison of the outcomes of these conditions. Objective. To investigate the neurological and functional recovery of ischemic compared with traumatic acute SCI. Methods. Data were derived from the European Multicenter Study Spinal Cord Injury database. Patients with ischemic (iSCI) or traumatic SCI (tSCI), aged 18 years or older were evaluated at different time points from incidence: at about 1 month, 3 months, and 6 months. The neurological status was assessed at each time point by the International Standards for Neurological Classification of Spinal Cord Injury and the functional status by the Spinal Cord Independence Measure. Walking ability was evaluated by Walking Index for Spinal Cord Injury, 10-Meter Walk Test, and 6-Minute Walk Test. Because of the imbalances of the 2 groups in respect to size and lesion severity, a matching procedure according to age, neurological level, and severity of injury was performed. Outcomes evaluation was performed by means of a 2-way repeated-measures ANOVA. Results. The matching procedure resulted in 191 pairs. Both groups significantly improved from about 15 days after the lesion to 6 months. No differences were found in the course of neurological and functional recovery of iSCI compared with tSCI. Conclusions. This analysis from a representative cohort of participants revealed that from 15 days following the cord damage onward, the outcomes after iSCI and tSCI are comparable. This finding supports the potential enrolment of patients with acute iSCI into clinical trials from that point in time after the event and an evaluation up to 6 months afterward.
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Affiliation(s)
| | | | | | - Doris D. Maier
- Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
| | | | | | | | - Rainer Abel
- Spinal Cord Injury Center, Bayreuth, Germany
| | | | - Kriz Jiri
- University Hospital Motol, Prague, Czech Republic
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14
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Comparison of outcomes between people with and without central cord syndrome. Spinal Cord 2020; 58:1263-1273. [DOI: 10.1038/s41393-020-0491-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 11/08/2022]
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15
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Brouwers EMJR, Meent HVD, Curt A, Maier DD, Abel RF, Weidner N, Rupp R, Kriz J, de Haan AFJ, Kramer JK, Hosman AJF, Bartels RHMA. Recovery after traumatic thoracic- and lumbar spinal cord injury: the neurological level of injury matters. Spinal Cord 2020; 58:980-987. [DOI: 10.1038/s41393-020-0463-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 03/26/2020] [Accepted: 03/30/2020] [Indexed: 12/13/2022]
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16
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Pavese C, Bachmann LM, Schubert M, Curt A, Mehnert U, Schneider MP, Scivoletto G, Finazzi Agrò E, Maier D, Abel R, Weidner N, Rupp R, Kessels AG, Kessler TM. Bowel Outcome Prediction After Traumatic Spinal Cord Injury: Longitudinal Cohort Study. Neurorehabil Neural Repair 2019; 33:902-910. [DOI: 10.1177/1545968319868722] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background. Predicting functional outcomes after traumatic spinal cord injury (SCI) is essential for counseling, rehabilitation planning, and discharge. Moreover, the outcome prognosis is crucial for patient stratification when designing clinical trials. However, no valid prediction rule is currently available for bowel outcomes after a SCI. Objective. To generate a model for predicting the achievement of independent, reliable bowel management at 1 year after traumatic SCI. Methods. We performed multivariable logistic regression analyses of data for 1250 patients with traumatic SCIs that were included in the European Multicenter Study about Spinal Cord Injury. The resulting model was prospectively validated on data for 186 patients. As potential predictors, we evaluated age, sex, and variables from the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and the Spinal Cord Independence Measure (SCIM), measured within 40 days of the injury. A positive outcome at 1 year post-SCI was assessed with item 7 of the SCIM. Results. The model relied on a single predictor, the ISNCSCI total motor score—that is, the sum of muscle strengths in 5 key muscle groups in each limb. The area under the receiver operating characteristics curve (aROC) was 0.837 (95% CI: 0.815-0.859). The prospective validation confirmed high predictive power: aROC = 0.817 (95% CI: 0.754-0.881). Conclusions. We generated a valid model for predicting independent, reliable bowel management at 1 year after traumatic SCI. Its application could improve counseling, optimize patient-tailored rehabilitation planning, and become crucial for appropriate patient stratification in future clinical trials.
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Affiliation(s)
- Chiara Pavese
- Balgrist University Hospital, University of Zürich, Zürich, Switzerland
- University of Pavia, Pavia, Italy; Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | | | - Martin Schubert
- Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Armin Curt
- Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Ulrich Mehnert
- Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Marc P. Schneider
- Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | | | | | | | | | | | - Rüdiger Rupp
- Heidelberg University Hospital, Heidelberg, Germany
| | | | - Thomas M. Kessler
- Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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17
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International Standards for Neurological Classification of Spinal Cord Injury: factors influencing the frequency, completion and accuracy of documentation of neurology for patients with traumatic spinal cord injuries. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1639-1648. [PMID: 31324967 PMCID: PMC6851215 DOI: 10.1007/s00590-019-02502-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/15/2019] [Indexed: 11/23/2022]
Abstract
Introduction We aim to evaluate the effects of injury-related factors and clinician training grades on the frequency, completion and accuracy of International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) charts in a tertiary care neurosurgery unit. Materials and methods We retrospectively analysed 96 ISNCSCI charts of 24 traumatic spinal cord-injured (SCI) patients and 26 controls (vertebral fracture but neurologically intact), written by 50 clinicians. Seven components of each ISNCSCI charts (motor scores, sensory scores, sensory levels, motor levels, neurological level of injury, SCI severity and AIS) were reviewed to evaluate the effect of injury factors and clinician grade on the completion and accuracy of the ISNCSCI components. Results The ISNCSCI chart was used 1.9 times on average during admission. The number of ISNCSCI assessments was significant in those with isolated spinal injuries (p = 0.03). The overall completion and accuracy rates of the assessed ISNCSCI chart components were 39% and 78.1%, respectively. Motor levels and AIS had the lowest completion rates. Motor levels and sensory levels had the lowest accuracy rates. The completion rate was higher in the charts of male patients, tetraplegic patients, and in patients with isolated spinal injuries. The junior clinicians had a significantly greater ISNCSCI chart completion rate than their seniors. However, the senior clinicians were more accurate in completing the ISNCSCI chart components. Conclusion The quality of ISNCSCI documentation remained poor regardless of the clinician training grade and injury factors. Clinicians should be educated on the ISNCSCI protocol and the importance of adequate documentation. Electronic supplementary material The online version of this article (10.1007/s00590-019-02502-7) contains supplementary material, which is available to authorized users.
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18
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Ulnar nerve integrity predicts 1-year outcome in cervical spinal cord injury. Neurol Res Pract 2019; 1:11. [PMID: 33324877 PMCID: PMC7650063 DOI: 10.1186/s42466-019-0017-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/25/2019] [Indexed: 11/24/2022] Open
Abstract
Background Accurate predictors of neurological recovery after cervical spinal cord injury are needed. Particularly, to tailor adequate rehabilitation plans. However, objective and quantifiable predictors are sparse. Methods Within the prospective European Multicenter Study about Spinal Cord Injury (EMSCI) registry, cervical spinal cord injury patients are monitored at fixed follow up visits (2, 4, 12, 24, and 48 weeks after injury) clinically and with ulnar nerve electroneurography. Associations of ulnar nerve compound muscle action potential amplitudes (CMAP) with American Spinal Cord Injury Association (ASIA) impairment scale (AIS) grades over time were analyzed using linear mixed modeling. Applying logistic regression, the prognostic value of within 4-week ulnar nerve CMAP for 1-year AIS was analyzed. To account for missing data, (1) last observation carried forward and (2) multiple imputation methods were applied. For model derivation, our centers’ cohort (EMSCI-HD) was analyzed. For model validation the cohort of other centers (EMSCI-nonHD) was used. Results In the EMSCI-HD cohort, the median age (interquartile range (IQR)) was 52 (34–67) years. 58% were male. The initial AIS distribution was: A = 31%, B = 17%, C = 30%, and D = 22%). In the EMSCI-nonHD cohort, the median age was 49 (32–65) years. Compared to the EMSCI-HD cohort more patients were male (79%, p = 0.0034). The AIS distribution was: A = 33%, B = 13%, C = 21%, and D = 33%). In complete-case mixed model analyses (EMSCI-HD: n = 114; EMSCI-nonHD: n = 508) higher ulnar nerve CMAP were associated with better AIS grades over the entire follow up period. In complete-case logistic regression (EMSCI-HD: n = 90; EMSCI-nonHD: n = 444) higher ulnar nerve CMAP was an independent predictor of better AIS grades. The odds ratio for within 4-week ulnar nerve CMAP to predict 1-year AIS grade D versus A-C in the EMSCI-HD cohort was 1.24 per millivolt (confidence interval 1.07–1.44). The model was validated in an independent cervical spinal cord injury (EMSCI-nonHD) cohort (odds ratio 1.09, confidence interval 1.03–1.17). Conclusions In cervical spinal cord injury, the consideration of early ulnar nerve CMAP improves prognostic accuracy, which is of particular importance in patients with clinical grading uncertainties. Electronic supplementary material The online version of this article (10.1186/s42466-019-0017-1) contains supplementary material, which is available to authorized users.
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19
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Assessor accuracy of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)-recommendations for reporting items. Spinal Cord 2018; 56:819-820. [PMID: 29904186 DOI: 10.1038/s41393-018-0133-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 03/27/2018] [Indexed: 11/09/2022]
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20
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Dvorak MF, Cheng CL, Fallah N, Santos A, Atkins D, Humphreys S, Rivers CS, White BA, Ho C, Ahn H, Kwon BK, Christie S, Noonan VK. Spinal Cord Injury Clinical Registries: Improving Care across the SCI Care Continuum by Identifying Knowledge Gaps. J Neurotrauma 2017; 34:2924-2933. [PMID: 28745934 PMCID: PMC5653140 DOI: 10.1089/neu.2016.4937] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Timely access and ongoing delivery of care and therapeutic interventions is needed to maximize recovery and function after traumatic spinal cord injury (tSCI). To ensure these decisions are evidence-based, access to consistent, reliable, and valid sources of clinical data is required. The Access to Care and Timing Model used data from the Rick Hansen SCI Registry (RHSCIR) to generate a simulation of healthcare delivery for persons after tSCI and to test scenarios aimed at improving outcomes and reducing the economic burden of SCI. Through model development, we identified knowledge gaps and challenges in the literature and current health outcomes data collection throughout the continuum of SCI care. The objectives of this article were to describe these gaps and to provide recommendations for bridging them. Accurate information on injury severity after tSCI was hindered by difficulties in conducting neurological assessments and classifications of SCI (e.g., timing), variations in reporting, and the lack of a validated SCI-specific measure of associated injuries. There was also limited availability of reliable data on patient factors such as multi-morbidity and patient-reported measures. Knowledge gaps related to structures (e.g., protocols) and processes (e.g., costs) at each phase of care have prevented comprehensive evaluation of system performance. Addressing these knowledge gaps will enhance comparative and cost-effectiveness evaluations to inform decision-making and standards of care. Recommendations to do so were: standardize data element collection and facilitate database linkages, validate and adopt more outcome measures for SCI, and increase opportunities for collaborations with stakeholders from diverse backgrounds.
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Affiliation(s)
- Marcel F. Dvorak
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Nader Fallah
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - Argelio Santos
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - Derek Atkins
- Operations and Logistics Division, Sauder School of Business, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Chester Ho
- Division of Physical Medicine and Rehabilitation, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Henry Ahn
- University of Toronto Spine Program, Toronto, Ontario, Canada
| | - Brian K. Kwon
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sean Christie
- Research Division of Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Franz S, Schuld C, Wilder-Smith E, Heutehaus L, Lang S, Gantz S, Schuh-Hofer S, Treede RD, Bryce T, Wang H, Weidner N. Spinal Cord Injury Pain Instrument and painDETECT questionnaire: Convergent construct validity in individuals with Spinal Cord Injury. Eur J Pain 2017; 21:1642-1656. [DOI: 10.1002/ejp.1069] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2017] [Indexed: 12/17/2022]
Affiliation(s)
- S. Franz
- Spinal Cord Injury Center; Heidelberg University Hospital; Heidelberg Germany
| | - C. Schuld
- Spinal Cord Injury Center; Heidelberg University Hospital; Heidelberg Germany
| | - E.P. Wilder-Smith
- Neurology; Yong Loo Lin School of Medicine; National University Singapore; Singapore
- Department of Neurology; Kantonsspital Lucerne; Lucerne Switzerland
| | - L. Heutehaus
- Spinal Cord Injury Center; Heidelberg University Hospital; Heidelberg Germany
| | - S. Lang
- Spinal Cord Injury Center; Heidelberg University Hospital; Heidelberg Germany
| | - S. Gantz
- Spinal Cord Injury Center; Heidelberg University Hospital; Heidelberg Germany
| | - S. Schuh-Hofer
- Chair of Neurophysiology; Centre of Biomedicine and Medical Technology Mannheim; Heidelberg University; Mannheim Germany
| | - R.-D. Treede
- Chair of Neurophysiology; Centre of Biomedicine and Medical Technology Mannheim; Heidelberg University; Mannheim Germany
| | - T.N. Bryce
- Department of Rehabilitation Medicine; Icahn School of Medicine at Mount Sinai; New York USA
| | - H. Wang
- Spinal Cord Injury Center; Heidelberg University Hospital; Heidelberg Germany
| | - N. Weidner
- Spinal Cord Injury Center; Heidelberg University Hospital; Heidelberg Germany
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Armstrong AJ, Clark JM, Ho DT, Payne CJ, Nolan S, Goodes LM, Harvey LA, Marshall R, Galea MP, Dunlop SA. Achieving assessor accuracy on the International Standards for Neurological Classification of Spinal Cord Injury. Spinal Cord 2017. [DOI: 10.1038/sc.2017.67] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Fisahn C, Aach M, Jansen O, Moisi M, Mayadev A, Pagarigan KT, Dettori JR, Schildhauer TA. The Effectiveness and Safety of Exoskeletons as Assistive and Rehabilitation Devices in the Treatment of Neurologic Gait Disorders in Patients with Spinal Cord Injury: A Systematic Review. Global Spine J 2016; 6:822-841. [PMID: 27853668 PMCID: PMC5110426 DOI: 10.1055/s-0036-1593805] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 09/27/2016] [Indexed: 02/07/2023] Open
Abstract
Study Design Systematic review. Clinical Questions (1) When used as an assistive device, do wearable exoskeletons improve lower extremity function or gait compared with knee-ankle-foot orthoses (KAFOs) in patients with complete or incomplete spinal cord injury? (2) When used as a rehabilitation device, do wearable exoskeletons improve lower extremity function or gait compared with other rehabilitation strategies in patients with complete or incomplete spinal cord injury? (3) When used as an assistive or rehabilitation device, are wearable exoskeletons safe compared with KAFO for assistance or other rehabilitation strategies for rehabilitation in patients with complete or incomplete spinal cord injury? Methods PubMed, Cochrane, and Embase databases and reference lists of key articles were searched from database inception to May 2, 2016, to identify studies evaluating the effectiveness of wearable exoskeletons used as assistive or rehabilitative devices in patients with incomplete or complete spinal cord injury. Results No comparison studies were found evaluating exoskeletons as an assistive device. Nine comparison studies (11 publications) evaluated the use of exoskeletons as a rehabilitative device. The 10-meter walk test velocity and Spinal Cord Independence Measure scores showed no difference in change from baseline among patients undergoing exoskeleton training compared with various comparator therapies. The remaining primary outcome measures of 6-minute walk test distance and Walking Index for Spinal Cord Injury I and II and Functional Independence Measure-Locomotor scores showed mixed results, with some studies indicating no difference in change from baseline between exoskeleton training and comparator therapies, some indicating benefit of exoskeleton over comparator therapies, and some indicating benefit of comparator therapies over exoskeleton. Conclusion There is no data to compare locomotion assistance with exoskeleton versus conventional KAFOs. There is no consistent benefit from rehabilitation using an exoskeleton versus a variety of conventional methods in patients with chronic spinal cord injury. Trials comparing later-generation exoskeletons are needed.
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Affiliation(s)
- Christian Fisahn
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, United States,Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany,Address for correspondence Christian Fisahn, MD Swedish Neuroscience Institute, Swedish Medical Center550 17th Avenue, Seattle, WA 98122United States
| | - Mirko Aach
- Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Oliver Jansen
- Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Marc Moisi
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, United States
| | - Angeli Mayadev
- Multiple Sclerosis Center, Swedish Medical Center, Seattle, Washington, United States
| | | | | | - Thomas A. Schildhauer
- Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
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Battistuzzo CR, Smith K, Skeers P, Armstrong A, Clark J, Agostinello J, Cox S, Bernard S, Freeman BJ, Dunlop SA, Batchelor PE. Early Rapid Neurological Assessment for Acute Spinal Cord Injury Trials. J Neurotrauma 2016; 33:1936-1945. [DOI: 10.1089/neu.2015.4360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Camila R. Battistuzzo
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Melbourne, VIC, Australia
| | - Karen Smith
- Department of Epidemiology and Preventive Medicine, Monash University and Ambulance Victoria, Melbourne VIC, Australia
| | - Peta Skeers
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Melbourne, VIC, Australia
| | - Alex Armstrong
- School of Animal Biology, The University of Western Australia, Perth, WA, Australia
| | - Jillian Clark
- Centre for Orthopaedic and Trauma Research, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Jacqui Agostinello
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Melbourne, VIC, Australia
| | - Shelley Cox
- Department of Epidemiology and Preventive Medicine, Monash University and Ambulance Victoria, Melbourne VIC, Australia
| | - Stephen Bernard
- Department of Epidemiology and Preventive Medicine, Monash University and Ambulance Victoria, Melbourne VIC, Australia
| | - Brian J.C. Freeman
- Centre for Orthopaedic and Trauma Research, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA, Australia
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Sarah A. Dunlop
- School of Animal Biology, The University of Western Australia, Perth, WA, Australia
| | - Peter E. Batchelor
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Melbourne, VIC, Australia
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Franz S, Kirshblum SC, Weidner N, Rupp R, Schuld C. Motor levels in high cervical spinal cord injuries: Implications for the International Standards for Neurological Classification of Spinal Cord Injury. J Spinal Cord Med 2016; 39:513-7. [PMID: 26913366 PMCID: PMC5020589 DOI: 10.1080/10790268.2016.1138602] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
CONTEXT/OBJECTIVE To verify the hypothesis that motor levels (ML) inferred from sensory levels in the upper cervical segments C2-C4 according to the current version of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) are counterintuitive in cases where the most rostral myotomes C5 and C6 are graded as intact. DESIGN Prospective cohort study of ISNCSCI instructional course participants completing a post-test after the workshop to determine the MLs in two variants of a complete, high cervical spinal cord injury (SCI) case scenario. Both variants were based on the same ISNCSCI sensory and MLs of C2. In the first variant myotomes C5 and C6 were bilaterally graded as intact, while in variant 2 only active movements against gravity were possible (grade 3). SETTING Eight ISNCSCI instructional courses conducted during the study period from November 2012 until March 2015 in the framework of the European Multicenter Study on Human Spinal Cord Injury (EMSCI- http//emsci.org ). PARTICIPANTS Ninety-two clinicians from twenty-two SCI centers. Most of the attendees were physicians (58.7%) or physical therapists (33.7%) and had less than one year (44.6%) experience in SCI medicine. INTERVENTIONS Not applicable. OUTCOME MEASURE The classification performance described as percentage of correctly determined MLs by the clinicians. RESULTS Variant 2 (89.13%) was significantly (P < 0.0001) better classified than variant 1 (65.76%). In variant 1 with intact myotomes at C5 and C6, C6 was incorrectly classified as the ML by the clinicians in 33.15% of all cases, whereas in variant 2 with non-intact C5 / C6 myotomes, C6 was rarely chosen (2.17%). CONCLUSIONS Sensory level deferred MLs in the high cervical region of C2-C4 are counterintuitive whenever the most rostral cervical myotomes are intact. An adjustment of the ML definition in ISNCSCI may be needed.
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Affiliation(s)
- Steffen Franz
- Heidelberg University Hospital, Spinal Cord Injury Center, Heidelberg, Germany
| | - Steven C. Kirshblum
- Kessler Institute for Rehabilitation, Rutgers/New Jersey Medical School, West Orange, NJ, USA
| | - Norbert Weidner
- Heidelberg University Hospital, Spinal Cord Injury Center, Heidelberg, Germany
| | - Rüdiger Rupp
- Heidelberg University Hospital, Spinal Cord Injury Center, Heidelberg, Germany,Correspondence to: Rüdiger Rupp, Heidelberg University Hospital, Spinal Cord Injury Center, 69118 Heidelberg, Germany.
| | - Christian Schuld
- Heidelberg University Hospital, Spinal Cord Injury Center, Heidelberg, Germany,Christian Schuld, Heidelberg University Hospital, Spinal Cord Injury Center, 69118 Heidelberg, Germany.
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Schuld C, Franz S, Brüggemann K, Heutehaus L, Weidner N, Kirshblum SC, Rupp R. International standards for neurological classification of spinal cord injury: impact of the revised worksheet (revision 02/13) on classification performance. J Spinal Cord Med 2016; 39:504-12. [PMID: 27301061 PMCID: PMC5020584 DOI: 10.1080/10790268.2016.1180831] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVES Comparison of the classification performance between the worksheet revisions of 2011 and 2013 of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). SETTINGS Ongoing ISNCSCI instructional courses of the European Multicenter Study on Human Spinal Cord Injury (EMSCI). For quality control all participants were requested to classify five ISNCSCI cases directly before (pre-test) and after (post-test) the workshop. PARTICIPANTS One hundred twenty-five clinicians working in 22 SCI centers attended the instructional course between November 2011 and March 2015. Seventy-two clinicians completed the post-test with the 2011 revision of the worksheet and 53 with the 2013 revision. INTERVENTIONS Not applicable. OUTCOME MEASURES The clinicians' classification performance assessed by the percentage of correctly determined motor levels (ML) and sensory levels, neurological levels of injury (NLI), ASIA Impairment Scales and zones of partial preservations. RESULTS While no group differences were found in the pre-tests, the overall performance (rev2011: 92.2% ± 6.7%, rev2013: 94.3% ± 7.7%; P = 0.010), the percentage of correct MLs (83.2% ± 14.5% vs. 88.1% ± 15.3%; P = 0.046) and NLIs (86.1% ± 16.7% vs. 90.9% ± 18.6%; P = 0.043) improved significantly in the post-tests. Detailed ML analysis revealed the largest benefit of the 2013 revision (50.0% vs. 67.0%) in a case with a high cervical injury (NLI C2). CONCLUSION The results from the EMSCI ISNCSCI post-tests show a significantly better classification performance using the revised 2013 worksheet presumably due to the body-side based grouping of myotomes and dermatomes and their correct horizontal alignment. Even with these proven advantages of the new layout, the correct determination of MLs in the segments C2-C4 remains difficult.
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Affiliation(s)
- Christian Schuld
- Heidelberg University Hospital, Spinal Cord Injury Center, Heidelberg, Germany,Correspondence to: Christian Schuld, Heidelberg University Hospital, Spinal Cord Injury Center, 69118 Heidelberg, Germany.
| | - Steffen Franz
- Heidelberg University Hospital, Spinal Cord Injury Center, Heidelberg, Germany
| | - Karin Brüggemann
- Heidelberg University Hospital, Spinal Cord Injury Center, Heidelberg, Germany
| | - Laura Heutehaus
- Heidelberg University Hospital, Spinal Cord Injury Center, Heidelberg, Germany
| | - Norbert Weidner
- Heidelberg University Hospital, Spinal Cord Injury Center, Heidelberg, Germany
| | - Steven C. Kirshblum
- Kessler Institute for Rehabilitation, West Orange, NJ, USA,Rutgers/New Jersey Medical School, Newark, NJ, USA
| | - Rüdiger Rupp
- Heidelberg University Hospital, Spinal Cord Injury Center, Heidelberg, Germany
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Cragg JJ, Haefeli J, Jutzeler CR, Röhrich F, Weidner N, Saur M, Maier DD, Kalke YB, Schuld C, Curt A, Kramer JK. Effects of Pain and Pain Management on Motor Recovery of Spinal Cord–Injured Patients. Neurorehabil Neural Repair 2016; 30:753-61. [DOI: 10.1177/1545968315624777] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Approximately 60% of patients suffering from acute spinal cord injury (SCI) develop pain within days to weeks after injury, which ultimately persists into chronic stages. To date, the consequences of pain after SCI have been largely examined in terms of interfering with quality of life. Objective. The objective of this study was to examine the effects of pain and pain management on neurological recovery after SCI. Methods. We analyzed clinical data in a prospective multicenter observational cohort study in patients with SCI. Using mixed effects regression techniques, total motor and sensory scores were modelled at 1, 3, 6, and 12 months postinjury. Results. A total of 225 individuals were included in the study (mean age: 45.8 ± 18 years, 80% male). At 1 month postinjury, 28% of individuals with SCI reported at- or below-level neuropathic pain. While pain classification showed no effect on neurological outcomes, individuals administered anticonvulsant medications at 1 month postinjury showed significant reductions in pain intensity (2 points over 1 year; P < .05) and greater recovery in total motor scores (7.3 points over 1 year; P < .05). This drug effect on motor recovery remained significant after adjustment for injury level and injury severity, pain classification, and pain intensity. Conclusion. While initial pain classification and intensity did not reveal an effect on motor recovery following acute SCI, anticonvulsants conferred a significant beneficial effect on motor outcomes. Early intervention with anticonvulsants may have effects beyond pain management and warrant further studies to evaluate the therapeutic effectiveness in human SCI.
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Affiliation(s)
- Jacquelyn J. Cragg
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Jenny Haefeli
- Brain and Spinal Injury Center, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | | | - Frank Röhrich
- Berufsgenossenschaftliche Klinik Bergmanstrost of Halle, Halle, Germany
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Marion Saur
- Orthopädische Klinik, Hessisch Lichtenau, Germany
| | | | - Yorck B. Kalke
- RKU Universitäts und Rehabilitationskliniken Ulm, Ulm, Germany
| | - Christian Schuld
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Armin Curt
- University Hospital Balgrist, Zurich, Switzerland
| | - John K. Kramer
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
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Walden K, Bélanger LM, Biering-Sørensen F, Burns SP, Echeverria E, Kirshblum S, Marino RJ, Noonan VK, Park SE, Reeves RK, Waring W, Dvorak MF. Development and validation of a computerized algorithm for International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). Spinal Cord 2016; 54:197-203. [PMID: 26323348 PMCID: PMC5399136 DOI: 10.1038/sc.2015.137] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/28/2015] [Accepted: 06/24/2015] [Indexed: 12/21/2022]
Abstract
STUDY DESIGN Validation study. OBJECTIVES To describe the development and validation of a computerized application of the international standards for neurological classification of spinal cord injury (ISNCSCI). SETTING Data from acute and rehabilitation care. METHODS The Rick Hansen Institute-ISNCSCI Algorithm (RHI-ISNCSCI Algorithm) was developed based on the 2011 version of the ISNCSCI and the 2013 version of the worksheet. International experts developed the design and logic with a focus on usability and features to standardize the correct classification of challenging cases. A five-phased process was used to develop and validate the algorithm. Discrepancies between the clinician-derived and algorithm-calculated results were reconciled. RESULTS Phase one of the validation used 48 cases to develop the logic. Phase three used these and 15 additional cases for further logic development to classify cases with 'Not testable' values. For logic testing in phases two and four, 351 and 1998 cases from the Rick Hansen SCI Registry (RHSCIR), respectively, were used. Of 23 and 286 discrepant cases identified in phases two and four, 2 and 6 cases resulted in changes to the algorithm. Cross-validation of the algorithm in phase five using 108 new RHSCIR cases did not identify the need for any further changes, as all discrepancies were due to clinician errors. The web-based application and the algorithm code are freely available at www.isncscialgorithm.com. CONCLUSION The RHI-ISNCSCI Algorithm provides a standardized method to accurately derive the level and severity of SCI from the raw data of the ISNCSCI examination. The web interface assists in maximizing usability while minimizing the impact of human error in classifying SCI. SPONSORSHIP This study is sponsored by the Rick Hansen Institute and supported by funding from Health Canada and Western Economic Diversification Canada.
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Affiliation(s)
- K Walden
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - L M Bélanger
- Rick Hansen Institute, Vancouver, British Columbia, Canada
- Vancouver Spine Program, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - F Biering-Sørensen
- Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Havnevej, Hornbaek, Denmark
| | - S P Burns
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - E Echeverria
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - S Kirshblum
- Kessler Institute for Rehabilitation, Rutgers New Jersey Medical School, West Orange, NJ, USA
| | - R J Marino
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - V K Noonan
- Rick Hansen Institute, Vancouver, British Columbia, Canada
- Department of Orthopedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - S E Park
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - R K Reeves
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - W Waring
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, USA
| | - M F Dvorak
- Vancouver Spine Program, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Department of Orthopedics, University of British Columbia, Vancouver, British Columbia, Canada
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Velstra IM, Bolliger M, Krebs J, Rietman JS, Curt A. Predictive Value of Upper Limb Muscles and Grasp Patterns on Functional Outcome in Cervical Spinal Cord Injury. Neurorehabil Neural Repair 2015; 30:295-306. [DOI: 10.1177/1545968315593806] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective. To determine which single or combined upper limb muscles as defined by the International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI); upper extremity motor score (UEMS) and the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP), best predict upper limb function and independence in activities of daily living (ADLs) and to assess the predictive value of qualitative grasp movements (QlG) on upper limb function in individuals with acute tetraplegia. Method. As part of a Europe-wide, prospective, longitudinal, multicenter study ISNCSCI, GRASSP, and Spinal Cord Independence Measure (SCIM III) scores were recorded at 1 and 6 months after SCI. For prediction of upper limb function and ADLs, a logistic regression model and unbiased recursive partitioning conditional inference tree (URP-CTREE) were used. Results. Logistic regression and URP-CTREE revealed that a combination of ISNCSCI and GRASSP muscles (to a maximum of 4) demonstrated the best prediction (specificity and sensitivity ranged from 81.8% to 96.0%) of upper limb function and identified homogenous outcome cohorts at 6 months. The URP-CTREE model with the QlG predictors for upper limb function showed similar results. Conclusion. Prediction of upper limb function can be achieved through a combination of defined, specific upper limb muscles assessed in the ISNCSCI and GRASSP. A combination of a limited number of proximal and distal muscles along with an assessment of grasping movements can be applied for clinical decision making for rehabilitation interventions and clinical trials.
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Affiliation(s)
| | - Marc Bolliger
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- European Multicenter Study about Human Spinal Cord Injury (EMSCI), Zurich, Switzerland
| | - Jörg Krebs
- Clinical Trial Unit, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Johan S. Rietman
- Roessingh Research and Development, Lab of Biomechanical Engineering, University of Twente, Enschede, Netherlands
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- European Multicenter Study about Human Spinal Cord Injury (EMSCI), Zurich, Switzerland
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Kirshblum S, Waring W. Updates for the International Standards for Neurological Classification of Spinal Cord Injury. Phys Med Rehabil Clin N Am 2015; 25:505-17, vii. [PMID: 25064785 DOI: 10.1016/j.pmr.2014.04.001] [Citation(s) in RCA: 176] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) is the most widely used classification in the field of spinal cord injury medicine. Since its first publication in 1982, multiple revisions refining the recommended examination, scaling, and classification have taken place to improve communication, consistency, and clarity. This article describes a brief historical perspective on the development and changes over the years leading to the current ISNCSCI, detailing the most recent updates of 2011 and the worksheet 2013 as well as issues facing the ISNCSCI for the future.
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Affiliation(s)
- Steven Kirshblum
- Kessler Institute for Rehabilitation, Rutgers New Jersey Medical School, West Orange, NJ 07052, USA; Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - William Waring
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, 9200 Wisconsin Avenue, Milwaukee, WI 53226, USA
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Safety and efficacy of at-home robotic locomotion therapy in individuals with chronic incomplete spinal cord injury: a prospective, pre-post intervention, proof-of-concept study. PLoS One 2015; 10:e0119167. [PMID: 25803577 PMCID: PMC4372343 DOI: 10.1371/journal.pone.0119167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 01/12/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The compact Motorized orthosis for home rehabilitation of Gait (MoreGait) was developed for continuation of locomotion training at home. MoreGait generates afferent stimuli of walking with the user in a semi-supine position and provides feedback about deviations from the reference walking pattern. OBJECTIVE Prospective, pre-post intervention, proof-of-concept study to test the feasibility of an unsupervised home-based application of five MoreGait prototypes in subjects with incomplete spinal cord injury (iSCI). METHODS Twenty-five (5 tetraplegia, 20 paraplegia) participants with chronic (mean time since injury: 5.8 ± 5.4 (standard deviation, SD) years) sensorimotor iSCI (7 ASIA Impairment Scale (AIS) C, 18 AIS D; Walking Index for Spinal Cord Injury (WISCI II): Interquartile range 9 to 16) completed the training (45 minutes / day, at least 4 days / week, 8 weeks). Baseline status was documented 4 and 2 weeks before and at training onset. Training effects were assessed after 4 and 8 weeks of therapy. RESULTS After therapy, 9 of 25 study participants improved with respect to the dependency on walking aids assessed by the WISCI II. For all individuals, the short-distance walking velocity measured by the 10-Meter Walk Test showed significant improvements compared to baseline (100%) for both self-selected (Mean 139.4% ± 35.5% (SD)) and maximum (Mean 143.1% ± 40.6% (SD)) speed conditions as well as the endurance estimated with the six-minute walk test (Mean 166.6% ± 72.1% (SD)). One device-related adverse event (pressure sore on the big toe) occurred in over 800 training sessions. CONCLUSIONS Home-based robotic locomotion training with MoreGait is feasible and safe. The magnitude of functional improvements achieved by MoreGait in individuals with iSCI is well within the range of complex locomotion robots used in hospitals. Thus, unsupervised MoreGait training potentially represents an option to prolong effective training aiming at recovery of locomotor function beyond in-patient rehabilitation. TRIAL REGISTRATION German Clinical Trials Register (DKRS) DRKS00005587.
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Velstra IM, Curt A, Frotzler A, Abel R, Kalsi-Ryan S, Rietman JS, Bolliger M. Changes in Strength, Sensation, and Prehension in Acute Cervical Spinal Cord Injury. Neurorehabil Neural Repair 2015; 29:755-66. [DOI: 10.1177/1545968314565466] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective. To investigate the internal and external responsiveness and recovery profiles of the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP) instrument in revealing changes in upper limb function within the first year following cervical spinal cord injury (SCI). Method. A European prospective, longitudinal, multicenter study assessing the GRASSP at 1, 3, 6, and 12 months after cervical SCI. Subtests of GRASSP were compared to the upper extremity motor (UEMS) and light touch scores (LT) according to the International Standards of Neurological Classification of Spinal Cord Injury (ISNCSCI), the Spinal Cord Independence Measure self-care subscore (SCIM-SS), as well as a clinician-rated outcome measure (CROM) of clinical relevance. Data were analyzed for GRASSP responsiveness and recovery rate over time. Results. Seventy-four participants entered the study. GRASSP subtests proved responsive (standardized response mean [SRM] ranged from 0.79 to 1.48 for strength, 0.50 to 1.03 for prehension, and 0.14 to 0.64 for sensation) between all examination time points. In comparison, UEMS and LT showed lower responsiveness (SRM UEMS ranged from 0.69 to 1.29 and SRM LT ranged from 0.30 to −0.13). All GRASSP subtests revealed significant, moderate-to-excellent correlations with UEMS, LT, and SCIM-SS at each time point, and changes in GRASSP subtests were in accordance with the CROM. GRASSP prehension and motor recovery was largest between 1 and 3 months. Conclusion. The GRASSP showed excellent responsiveness, detecting distinct changes in strength and prehension relating to the severity of cervical SCI. It detected clinically significant changes complimentary to the ISNCSCI and SCIM-SS assessments.
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Affiliation(s)
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- European Multicenter Study about Human Spinal Cord Injury (EMSCI)
| | - Angela Frotzler
- Clinical Trial Unit, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Rainer Abel
- Spinal Cord Injury Center, Hohe Warte, Bayreuth, Germany
| | - Sukhvinder Kalsi-Ryan
- Krembil Neuroscience Program, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Johan S. Rietman
- Roessingh Research and Development, Lab of Biomechanical Engineering, University of Twente, Enschede, Netherlands
| | - Marc Bolliger
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- European Multicenter Study about Human Spinal Cord Injury (EMSCI)
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Schuld C, Franz S, van Hedel HJA, Moosburger J, Maier D, Abel R, van de Meent H, Curt A, Weidner N, Rupp R. International standards for neurological classification of spinal cord injury: classification skills of clinicians versus computational algorithms. Spinal Cord 2014; 53:324-31. [DOI: 10.1038/sc.2014.221] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 11/03/2014] [Accepted: 11/11/2014] [Indexed: 12/14/2022]
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Kirshblum SC, Biering-Sørensen F, Betz R, Burns S, Donovan W, Graves DE, Johansen M, Jones L, Mulcahey MJ, Rodriguez GM, Schmidt-Read M, Steeves JD, Tansey K, Waring W. International standards for neurological classification of spinal cord injury: cases with classification challenges. Top Spinal Cord Inj Rehabil 2014; 20:81-9. [PMID: 25477729 DOI: 10.1310/sci2002-81] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI) is routinely used to determine levels of injury and to classify the severity of the injury. Questions are often posed to the International Standards Committee of the American Spinal Injury Association (ASIA) regarding the classification. The committee felt that disseminating some of the challenging questions posed, as well as the responses, would be of benefit for professionals utilizing the ISNCSCI. Case scenarios that were submitted to the committee are presented with the responses as well as the thought processes considered by the committee members. The importance of this documentation is to clarify some points as well as update the SCI community regarding possible revisions that will be needed in the future based upon some rules that require clarification.
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Affiliation(s)
- S C Kirshblum
- Kessler Institute for Rehabilitation, West Orange, New Jersey, and Rutgers New Jersey Medical School , Newark, New Jersey
| | - F Biering-Sørensen
- Clinic for Spinal Cord Injuries, Glostrup University Hospital, and Faculty of Health Sciences, University of Copenhagen , Denmark
| | - R Betz
- Shriners Hospitals for Children-Philadelphia , Philadelphia, Pennsylvania
| | - S Burns
- University of Washington School of Medicine , Seattle, Washington
| | - W Donovan
- The Institute for Rehabilitation & Research , Houston, Texas
| | - D E Graves
- University of Louisville , Louisville, Kentucky
| | | | - L Jones
- Craig H. Neilsen Foundation , Encino, California
| | - M J Mulcahey
- Jefferson School of Health Professions, Thomas Jefferson University , Philadelphia, Pennsylvania
| | - G M Rodriguez
- University of Michigan Hospital and Health Systems , Ann Arbor, Michigan
| | - M Schmidt-Read
- Magee Rehabilitation Hospital , Philadelphia, Pennsylvania
| | - J D Steeves
- International Collaboration On Repair Discoveries, University of British Columbia , Vancouver, British Columbia, Canada
| | - K Tansey
- Departments of Neurology and Physiology, Emory University School of Medicine, and Veterans Administration Medical Center , Atlanta, Georgia
| | - W Waring
- Medical College of Wisconsin , Milwaukee, Wisconsin
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Schliessmann D, Schuld C, Schneiders M, Derlien S, Glöckner M, Gladow T, Weidner N, Rupp R. Feasibility of visual instrumented movement feedback therapy in individuals with motor incomplete spinal cord injury walking on a treadmill. Front Hum Neurosci 2014; 8:416. [PMID: 24987344 PMCID: PMC4060051 DOI: 10.3389/fnhum.2014.00416] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 05/23/2014] [Indexed: 11/15/2022] Open
Abstract
Background: Incomplete spinal cord injury (iSCI) leads to motor and sensory deficits. Even in ambulatory persons with good motor function an impaired proprioception may result in an insecure gait. Limited internal afferent feedback (FB) can be compensated by provision of external FB by therapists or technical systems. Progress in computational power of motion analysis systems allows for implementation of instrumented real-time FB. The aim of this study was to test if individuals with iSCI can normalize their gait kinematics during FB and more importantly maintain an improvement after therapy. Methods: Individuals with chronic iSCI had to complete 6 days (1 day per week) of treadmill-based FB training with a 2 weeks pause after 3 days of training. Each day consists of an initial gait analysis followed by 2 blocks with FB/no-FB. During FB the deviation of the mean knee angle during swing from a speed matched reference (norm distance, ND) is visualized as a number. The task consists of lowering the ND, which was updated after every stride. Prior to the tests in patients the in-house developed FB implementation was tested in healthy subjects with an artificial movement task. Results: Four of five study participants benefited from FB in the short and medium term. Decrease of mean ND was highest during the first 3 sessions (from 3.93 ± 1.54 to 2.18 ± 1.04). After the pause mean ND stayed in the same range than before. In the last 3 sessions the mean ND decreased slower (2.40 ± 1.18 to 2.20 ± 0.90). Direct influences of FB ranged from 60 to 15% of reduction in mean ND compared to initial gait analysis and from 20 to 1% compared to no-FB sessions. Conclusions: Instrumented kinematic real-time FB may serve as an effective adjunct to established gait therapies in normalizing the gait pattern after incomplete spinal cord injury. Further studies with larger patient groups need to prove long term learning and the successful transfer of newly acquired skills to activities of daily living.
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Affiliation(s)
- Daniel Schliessmann
- Experimental Neurorehabilitation, Spinal Cord Injury Center, Heidelberg University Hospital Heidelberg, Germany
| | - Christian Schuld
- Experimental Neurorehabilitation, Spinal Cord Injury Center, Heidelberg University Hospital Heidelberg, Germany
| | - Matthias Schneiders
- Experimental Neurorehabilitation, Spinal Cord Injury Center, Heidelberg University Hospital Heidelberg, Germany
| | - Steffen Derlien
- Institut für Physiotherapie, University Hospital Jena Jena, Germany
| | - Maria Glöckner
- Institut für Physiotherapie, University Hospital Jena Jena, Germany
| | | | - Norbert Weidner
- Experimental Neurorehabilitation, Spinal Cord Injury Center, Heidelberg University Hospital Heidelberg, Germany
| | - Rüdiger Rupp
- Experimental Neurorehabilitation, Spinal Cord Injury Center, Heidelberg University Hospital Heidelberg, Germany
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Kirshblum SC, Biering-Sorensen F, Betz R, Burns S, Donovan W, Graves DE, Johansen M, Jones L, Mulcahey MJ, Rodriguez GM, Schmidt-Read M, Steeves JD, Tansey K, Waring W. International Standards for Neurological Classification of Spinal Cord Injury: cases with classification challenges. J Spinal Cord Med 2014; 37:120-7. [PMID: 24559416 PMCID: PMC4066420 DOI: 10.1179/2045772314y.0000000196] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI) is routinely used to determine the levels of injury and to classify the severity of the injury. Questions are often posed to the International Standards Committee of the American Spinal Injury Association regarding the classification. The committee felt that disseminating some of the challenging questions posed, as well as the responses, would be of benefit for professionals utilizing the ISNCSCI. Case scenarios that were submitted to the committee are presented with the responses as well as the thought processes considered by the committee members. The importance of this documentation is to clarify some points as well as update the SCI community regarding possible revisions that will be needed in the future based upon some rules that require clarification.
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Affiliation(s)
- S. C. Kirshblum
- Kessler Institute for Rehabilitation, Rutgers/New Jersey Medical School, West orange, NJ, USA,Correspondence to: S. C. Kirshblum, Kessler Institute for Rehabilitation, Rutgers/New Jersey Medical School, West Orange, NJ 07052, USA.
| | - F. Biering-Sorensen
- Clinic for Spinal Cord Injuries, Glostrup University Hospital and Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - R. Betz
- Shriners Hospitals for Children – Philadelphia, Philadelphia, PA, USA
| | - S. Burns
- University of Washington School of Medicine, Seattle, WA, USA
| | - W. Donovan
- The Institute for Rehabilitation and Research, Houston, TX, USA
| | | | | | - L. Jones
- Linda Jones PT, MS. Craig H. Neilsen Foundation, Encino, CA, USA
| | - M. J. Mulcahey
- Jefferson School of Health Professions, Thomas Jefferson University, Philadelphia, PA, USA
| | - G. M. Rodriguez
- University of Michigan Hospital and Health Systems, Ann Arbor, MI, USA
| | | | - J. D. Steeves
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
| | - K. Tansey
- Departments of Neurology and Physiology, Emory University School of Medicine, Veterans Administration Medical Center, Atlanta, GA, USA
| | - W. Waring
- Medical College of Wisconsin, Milwaukee, WI, USA
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Velstra IM, Bolliger M, Tanadini LG, Baumberger M, Abel R, Rietman JS, Curt A. Prediction and Stratification of Upper Limb Function and Self-Care in Acute Cervical Spinal Cord Injury With the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP). Neurorehabil Neural Repair 2014; 28:632-42. [DOI: 10.1177/1545968314521695] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. There is inherent heterogeneity within individuals suffering from cervical spinal cord injury (SCI), and early prediction of upper limb function and self-care is challenging. As a result, considerable uncertainty exists regarding the prediction of functional outcome following cervical SCI within 1 year of injury. Objective. To evaluate the value of Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP) in predicting upper limb function and self-care outcomes in individuals with cervical SCI. Method. A prospective longitudinal multicenter study was performed. Data from the GRASSP, the Spinal Cord Independence Measure (SCIM III), and the American Spinal Injury Association (ASIA) Impairment Scale were recorded at 1, 6, and 12 months after cervical SCI. For prediction of functional outcome at 6 and 12 months, a logistic regression model, receiver operating characteristics (ROC), and unbiased recursive partitioning conditional inference tree (URP-CTREE) were used with 8 different predictor variables. Results. Logistic regression analysis, ROC analysis, and URP-CTREE all revealed that the strength subtest within GRASSP is the strongest predictor for upper limb function and self-care outcomes. URP-CTREE provides useful information on the distribution of different outcomes in acute cervical SCI and can be used to predict cohorts with homogeneous outcomes. Conclusion. The GRASSP at 1 month can accurately predict upper limb function and self-care outcomes even in a heterogeneous group of individuals across a wide spectrum of neurological recovery. The application of URP-CTREE can reveal the distribution of outcome categories and, based on this, inform trial protocols with respect to outcomes analysis and patient stratification.
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Affiliation(s)
| | - Marc Bolliger
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- European Multicenter Study about Human Spinal Cord Injury (EMSCI)
| | | | - Michael Baumberger
- Department of Acute and Rehabilitation Medicine, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Rainer Abel
- Spinal Cord Injury Center, Hohe Warte, Bayreuth, Germany
| | - Johan S. Rietman
- Roessingh Research and Development, Lab of Biomechanical Engineering, University of Twente, Enschede, Netherlands
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- European Multicenter Study about Human Spinal Cord Injury (EMSCI)
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Abstract
Over the past 2 decades, the biological understanding of the mechanisms underlying structural and functional repair of the injured central nervous system has strongly increased. This has resulted in the development of multiple experimental treatment strategies with the collective aim of enhancing and surpassing the limited spontaneous recovery occurring in animal models and ultimately humans suffering from spinal cord or brain injuries. Several of these experimental treatments have revealed beneficial effects in animal models of spinal cord injury. With the exception of neurorehabilitative therapies, however, therapeutic interventions that enhance recovery are currently absent within the clinical realm of spinal cord injury. The present review surveys the prospects and challenges in experimental and clinical spinal cord repair. Major shortcomings in experimental research center on the difficulty of closely modeling human traumatic spinal cord injury in animals, the small number of investigations done on cervical spinal injury and tetraplegia, and the differences in lesion models, species, and functional outcome parameters used between laboratories. The main challenges in the clinical field of spinal cord repair are associated with the standardization and sensitivity of functional outcome measures, the definition of the inclusion/exclusion criteria for patient recruitment in trials, and the accuracy and reliability of an early diagnosis to predict subsequent neurological outcome. Research and clinical networks were recently created with the goal of optimizing animal studies and human trials. Promising clinical trials are currently in progress. The time has come to translate the biologic-mechanistic knowledge from basic science into efficacious treatments able to improve the conditions of humans suffering from spinal cord injury.
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Affiliation(s)
- Linard Filli
- Brain Research Institute, University Zurich and Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
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Schuld C, Wiese J, Franz S, Putz C, Stierle I, Smoor I, Weidner N, Rupp R. Effect of formal training in scaling, scoring and classification of the International Standards for Neurological Classification of Spinal Cord Injury. Spinal Cord 2012. [PMID: 23184026 DOI: 10.1038/sc.2012.149] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Prospective, longitudinal cohort study. OBJECTIVES To quantify the effect of formal training in the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) on the classification accuracy and to identify the most difficult ISNCSCI rules. SETTINGS European Multicenter Study on Human Spinal Cord Injury (EMSCI). METHODS EMSCI participants rated five challenging cases of full sensory, motor and anorectal examinations before (pre-test) and after (post-test) an ISNCSCI instructional course. Classification variables included sensory and motor levels (ML), completeness, ASIA Impairment Scale (AIS) and the zones of partial preservation. RESULTS 106 attendees were trained in 10 ISNCSCI workshops since 2006. The number of correct classifications increased significantly (P<0.00001) from 49.6% (2628 of 5300) in pre-testing to 91.5% (4849 of 5300) in post-testing. Every attendee improved, 12 (11.3%) achieved 100% correctness. Sensory levels (96.8%) and completeness (96.2%) are easiest to rate in post-testing, while ML (81.9%) and AIS (88.1%) are more difficult to determine. Most of the errors in ML determination arise from sensory levels in the high cervical region (C2-C4), where by convention the ML is presumed to be the same as the sensory level. The most difficult step in AIS classification is the determination of motor incompleteness. CONCLUSION ISNCSCI training significantly improves the classification skills regardless of the experience in spinal cord injury medicine. These findings need to be considered for the appropriate preparation and interpretation of clinical trials in spinal cord injury.
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Affiliation(s)
- C Schuld
- Heidelberg University Hospital, Spinal Cord Injury Center, Heidelberg, Germany.
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Spiess MR, Jaramillo JP, Behrman AL, Teraoka JK, Patten C. Unexpected Recovery After Robotic Locomotor Training at Physiologic Stepping Speed: A Single-Case Design. Arch Phys Med Rehabil 2012; 93:1476-84. [DOI: 10.1016/j.apmr.2012.02.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Revised: 02/21/2012] [Accepted: 02/25/2012] [Indexed: 01/10/2023]
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