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Ge Y, Lai Q, Guo W, Xu X. Risk factors for postoperative late deterioration in patients with spinal dural arteriovenous fistulas. Front Neurol 2024; 15:1412237. [PMID: 39040537 PMCID: PMC11260714 DOI: 10.3389/fneur.2024.1412237] [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: 04/08/2024] [Accepted: 06/20/2024] [Indexed: 07/24/2024] Open
Abstract
Background Approximately 86% of patients with spinal dural arteriovenous fistulas (SDVAFs) exhibit clinical improvement after surgery. However, 12%-55.8% of these patients experience late deterioration (LD) after an initial period of improvement. The risk factors for LD remain unclear. The aim of this study was to explore the risk factors for LD in SDVAF patients. Methods The clinical data of patients who were admitted to two tertiary hospitals between June 2014 and May 2022 were reviewed. Patients were divided into two groups: the LD group and the no LD group. The severity of neurological dysfunction (NDF) was evaluated using the Modified Aminoff and Logue Scale. Univariable and multivariable Cox regression analyses were performed. Results A total of 105 eligible patients were enrolled, with a mean age of 57.55 ± 9.42 years. The LD group comprised 37 individuals, while the no LD group consisted of 68 individuals. According to the univariable analysis, preoperative NDF severity and treatment strategy were associated with the risk of LD. According to the multivariable analysis, patients who underwent microsurgery (MS) had a lower risk of LD than did those who underwent endovascular treatment (EVT; HR 0.197, 95% CI 0.085-0.457), and patients with severe NDF had a higher risk of LD than did those with mild NDF (HR 3.604, 95% CI 1.226-10.588), whereas the risk of LD in patients with moderate NDF was similar to that of patients with mild NDF (HR 1.352, 95% CI 0.519-3.524). Conclusion EVT and severe preoperative NDF are independent risk factors for LD.
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Affiliation(s)
- Yuanhong Ge
- Department of Neurosurgery, Chengdu Second People’s Hospital, Chengdu, China
| | - Qingjia Lai
- Department of Rehabilitation, Care Alliance Rehabilitation Hospital of Chengdu, Chengdu, China
| | - Wei Guo
- Department of Neurosurgery, Tangdu Hospital, Air Force Military Medical University, Xi’an, China
| | - Xuejun Xu
- Department of Neurosurgery, Chengdu Second People’s Hospital, Chengdu, China
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Yoo HJ, Koo B, Yong CW, Lee KS. Prediction of gait recovery using machine learning algorithms in patients with spinal cord injury. Medicine (Baltimore) 2024; 103:e38286. [PMID: 38847729 PMCID: PMC11155515 DOI: 10.1097/md.0000000000038286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/26/2024] [Indexed: 06/10/2024] Open
Abstract
With advances in artificial intelligence, machine learning (ML) has been widely applied to predict functional outcomes in clinical medicine. However, there has been no attempt to predict walking ability after spinal cord injury (SCI) based on ML. In this situation, the main purpose of this study was to predict gait recovery after SCI at discharge from an acute rehabilitation facility using various ML algorithms. In addition, we explored important variables that were related to the prognosis. Finally, we attempted to suggest an ML-based decision support system (DSS) for predicting gait recovery after SCI. Data were collected retrospectively from patients with SCI admitted to an acute rehabilitation facility between June 2008 to December 2021. Linear regression analysis and ML algorithms (random forest [RF], decision tree [DT], and support vector machine) were used to predict the functional ambulation category at the time of discharge (FAC_DC) in patients with traumatic or non-traumatic SCI (n = 353). The independent variables were age, sex, duration of acute care and rehabilitation, comorbidities, neurological information entered into the International Standards for Neurological Classification of SCI worksheet, and somatosensory-evoked potentials at the time of admission to the acute rehabilitation facility. In addition, the importance of variables and DT-based DSS for FAC_DC was analyzed. As a result, RF and DT accurately predicted the FAC_DC measured by the root mean squared error. The root mean squared error of RF and the DT were 1.09 and 1.24 for all participants, 1.20 and 1.06 for those with trauma, and 1.12 and 1.03 for those with non-trauma, respectively. In the analysis of important variables, the initial FAC was found to be the most influential factor in all groups. In addition, we could provide a simple DSS based on strong predictors such as the initial FAC, American Spinal Injury Association Impairment Scale grades, and neurological level of injury. In conclusion, we provide that ML can accurately predict gait recovery after SCI for the first time. By focusing on important variables and DSS, we can guide early prognosis and establish personalized rehabilitation strategies in acute rehabilitation hospitals.
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Affiliation(s)
- Hyun-Joon Yoo
- Korea University Research Institute for Medical Bigdata Science, Korea University College of Medicine, Seoul, Republic of Korea
| | - Bummo Koo
- School of Health and Environmental Science, Korea University College of Health Science, Seoul, Republic of Korea
| | - Chan-woo Yong
- School of Health and Environmental Science, Korea University College of Health Science, Seoul, Republic of Korea
| | - Kwang-Sig Lee
- AI Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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3
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Nori S, Watanabe K, Takeda K, Yamane J, Kono H, Yokogawa N, Sasagawa T, Ando K, Nakashima H, Segi N, Funayama T, Eto F, Yamaji A, Furuya T, Yunde A, Nakajima H, Yamada T, Hasegawa T, Terashima Y, Hirota R, Suzuki H, Imajo Y, Ikegami S, Uehara M, Tonomura H, Sakata M, Hashimoto K, Onoda Y, Kawaguchi K, Haruta Y, Uei H, Sawada H, Nakanishi K, Misaki K, Terai H, Tamai K, Shirasawa E, Inoue G, Kiyasu K, Iizuka Y, Takasawa E, Funao H, Kaito T, Yoshii T, Ishihara M, Okada S, Imagama S, Kato S. Influence of the timing of surgery for cervical spinal cord injury without bone injury in the elderly: A retrospective multicenter study. J Orthop Sci 2024; 29:480-485. [PMID: 36720671 DOI: 10.1016/j.jos.2023.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 01/07/2023] [Accepted: 01/12/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND Although previous studies have demonstrated the advantages of early surgery for traumatic spinal cord injury (SCI), the appropriate surgical timing for cervical SCIs (CSCIs) without bone injury remains controversial. Here, we investigated the influence of relatively early surgery within 48 h of injury on the neurological recovery of elderly patients with CSCI and no bone injury. METHODS In this retrospective multicenter study, we reviewed data from 159 consecutive patients aged ≥65 years with CSCI without bone injury who underwent surgery in participating centers between 2010 and 2020. Patients were followed up for at least 6 months following CSCI. We divided patients into relatively early (≤48 h after CSCI, n = 24) and late surgery (>48 h after CSCI, n = 135) groups, and baseline characteristics and neurological outcomes were compared between them. Multivariate analysis was performed to identify factors associated with neurological recovery. RESULTS The relatively early surgery group demonstrated a lower prevalence of cardiac disease, poorer baseline American Spinal Injury Association (ASIA) impairment scale grade, and lower baseline ASIA motor score (AMS) than those of the late surgery group (P < 0.030, P < 0.001, and P < 0.001, respectively). Although the AMS was lower in the relatively early surgery group at 6 months following injury (P = 0.001), greater improvement in this score from baseline to 6-months post injury was observed (P = 0.010). Multiple linear regression analysis revealed that relatively early surgery did not affect postoperative improvement in AMS, rather, lower baseline AMS was associated with better AMS improvement (P < 0.001). Delirium (P = 0.006), pneumonia (P = 0.030), and diabetes mellitus (P = 0.039) negatively influenced postoperative improvement. CONCLUSIONS Although further validation by future studies is required, relatively early surgery did not show a positive influence on neurological recovery after CSCI without bone injury in the elderly.
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Affiliation(s)
- Satoshi Nori
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Kazuki Takeda
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan; Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, 8-2 Otemachi, Aoi-ku, Shizuoka, 420-0853, Japan
| | - Junichi Yamane
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan; Department of Orthopaedic Surgery, National Hospital Organization Murayama Medical Center, 2-37-1 Gakuen, Musashimurayama-shi, Tokyo, 208-0011, Japan
| | - Hitoshi Kono
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan; Keiyu Orthopedic Hospital, 2267 Akodacho, Tatebayashi-shi, Gunma, 374-0013, Japan
| | - Noriaki Yokogawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Takeshi Sasagawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan; Department of Orthopaedic Surgery, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae, Toyama, Toyama, 930-8550, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Naoki Segi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Toru Funayama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Fumihiko Eto
- Department of Orthopaedic Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Akihiro Yamaji
- Department of Orthopaedic Surgery, Ibaraki Seinan Medical Center Hospital, 2190, Sakaimachi, Sashima, Ibaraki, 306-0433, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Atsushi Yunde
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Hideaki Nakajima
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Tomohiro Yamada
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan; Department of Orthopaedic Surgery, Nagoya Kyoritsu Hospital, 1-172 Hokke, Nakagawa-ku, Nagoya-shi, Aichi, 454-0933, Japan
| | - Tomohiko Hasegawa
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Yoshinori Terashima
- Department of Orthopaedic Surgery, Sapporo Medical University, South 1-West 16-291, Chuo-ku, Sapporo, 060-8543, Japan; Department of Orthopaedic Surgery, Matsuda Orthopedic Memorial Hospital, North 18-East 4-1 Kita-ku, Sapporo, 001-0018, Japan
| | - Ryosuke Hirota
- Department of Orthopaedic Surgery, Sapporo Medical University, South 1-West 16-291, Chuo-ku, Sapporo, 060-8543, Japan
| | - Hidenori Suzuki
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube City, Yamaguchi, 755-8505, Japan
| | - Yasuaki Imajo
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube City, Yamaguchi, 755-8505, Japan
| | - Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Masashi Uehara
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hitoshi Tonomura
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Munehiro Sakata
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan; Department of Orthopaedics, Saiseikai Shiga Hospital, 2-4-1 Ohashi Ritto, Shiga, 520-3046, Japan
| | - Ko Hashimoto
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Yoshito Onoda
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Kenichi Kawaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yohei Haruta
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hiroshi Uei
- Department of Orthopaedic Surgery, Nihon University Hospital, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8393, Japan; Department of Orthopaedic Surgery, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Hirokatsu Sawada
- Department of Orthopaedic Surgery, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Kazuo Nakanishi
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Kosuke Misaki
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Hidetomi Terai
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka-city, Osaka, 545-8585, Japan
| | - Koji Tamai
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka-city, Osaka, 545-8585, Japan
| | - Eiki Shirasawa
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Katsuhito Kiyasu
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, 783-8505, Japan
| | - Yoichi Iizuka
- Department of Orthopaedic Surgery, Gunma University, Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Eiji Takasawa
- Department of Orthopaedic Surgery, Gunma University, Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Haruki Funao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 852 Hatakeda, Narita, Chiba, 286-0124, Japan; Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-0124, Japan; Department of Orthopaedic Surgery and Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan
| | - Takashi Kaito
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Masayuki Ishihara
- Department of Orthopaedic Surgery, Kansai Medical University Hospital, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan
| | - Seiji Okada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Satoshi Kato
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
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Morooka Y, Kunisawa Y, Okubo Y, Araki S, Takakura Y. Effects of early mobilization within 48 hours of injury in patients with incomplete cervical spinal cord injury. J Spinal Cord Med 2024:1-9. [PMID: 38265416 DOI: 10.1080/10790268.2024.2304919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE To investigate the effects of early mobilization within 48 h of injury on motor function and walking ability in patients with incomplete cervical spinal cord injury (SCI). DESIGN A retrospective observational study. SETTING Intensive care unit or high care unit of a university hospital emergency center. PARTICIPANTS Of 224 patients with SCI having American Spinal Injury Association impairment scale grades C and D, 158 consecutive patients hospitalized for at least 3 weeks after injury were included. INTERVENTIONS Patients were categorized into two groups: an early mobilization group in which patients were mobilized within 48 h of injury and a delayed mobilization group in which they were mobilized after 48 h of injury. OUTCOME MEASURES The upper extremity motor score (UEMS), lower extremity motor score (LEMS), and Walking Index for Spinal Cord Injury II (WISCI II) were compared using propensity score matching analysis. RESULTS Of the 158 patients who met the eligibility criteria, 32 were matched between the groups. There was a significant difference in the change in LEMS from the initial assessment to the assessment 2 weeks postoperatively in the early mobilization group (median 9 points vs. 3 points, p < 0.05). There were no significant differences in UEMS or WISCI II. CONCLUSION Early mobilization within 48 h may improve lower extremity motor function in patients with acute incomplete cervical SCI.
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Affiliation(s)
- Yusuke Morooka
- Faculty of Health, Department of Physical Therapy, Saitama Medical University, Saitama, Japan
| | - Yosuke Kunisawa
- Faculty of Health, Department of Physical Therapy, Saitama Medical University, Saitama, Japan
| | - Yuya Okubo
- Saitama Medical Center, Department of Rehabilitation, Kawagoe, Japan
| | - Shinta Araki
- Saitama Medical Center, Department of Rehabilitation, Kawagoe, Japan
| | - Yasuyuki Takakura
- Faculty of Health, Department of Physical Therapy, Saitama Medical University, Saitama, Japan
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Bae Y, Jung H, Shin N, Rahmati M, Udeh R, Kazemi A, Li Y, Solmi M, Syafrudin M, Fitriyani NL, Fond G, Boyer L, Lee SW. Musculoskeletal morbidity in adults with spinal cord injuries: A nationwide cohort study. NeuroRehabilitation 2024; 54:599-610. [PMID: 38669487 DOI: 10.3233/nre-230263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
BACKGROUND An increase in the demand for quality of life following spinal cord injuries (SCIs) is associated with an increase in musculoskeletal (MSK) pain, highlighting the need for preventive measure research. OBJECTIVE This study aimed to evaluate the incidence and hazards of MSK morbidities among Korean adults with SCIs, as well as the influence of SCI location on MSK morbidities. METHODS Patient populations were selected from Korean National Health Insurance Service data (n = 276). The control group included individuals without SCIs (n = 10,000). We compared the incidences and determined the unadjusted and adjusted hazard ratios (HRs) of common MSK morbidities (osteoarthritis, connective tissue disorders, sarcopenia, myalgia, neuralgia, rheumatoid arthritis, myositis, and musculoskeletal infections) based on the location of injury (cervical, thoracic, or lumbar). RESULTS Adults with SCIs had a higher incidence of MSK morbidity (48.45% vs. 36.6%) and a lower survival probability than those without SCIs. The incidence of MSK morbidity and survival probabilities were not significantly different for cervical cord injuries, whereas both measures were significantly different for thoracic and lumbar injuries. CONCLUSION SCI increases the risk of MSK morbidity. Lumbar SCI is associated with a higher incidence and risk of MSK morbidity than are cervical or thoracic SCIs.
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Affiliation(s)
- Youngoh Bae
- Department of Neurosurgery, Pohang Naval Hospital, Pohang, Korea
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea
- Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hohyun Jung
- Department of Statistics, Sungshin Women's University, Seoul, Korea
- Data Science Center, Sungshin Women's University, Seoul, Korea
| | - Nakyung Shin
- Department of Statistics, Sungshin Women's University, Seoul, Korea
| | - Masoud Rahmati
- CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Raphael Udeh
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Ultimo, NSW, Australia
| | - Abdolreza Kazemi
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Yusheng Li
- Deparment of Orthopedics, Xiangya Hospital, Central South University, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Marco Solmi
- Department of Psychiatry, SCIENCES Lab, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, Regional Centre for the Treatment of Eating Disorders and On Track: The Champlain First Episode Psychosis Program, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Muhammad Syafrudin
- Department of Artificial Intelligence and Data Science, Sejong University, Seoul, Korea
| | - Norma Latif Fitriyani
- Department of Artificial Intelligence and Data Science, Sejong University, Seoul, Korea
| | - Guillaume Fond
- CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
- FondaMental Foundation, Créteil, France
| | - Laurent Boyer
- CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
- FondaMental Foundation, Créteil, France
| | - Seung Won Lee
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea
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6
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Kishikawa J, Kobayakawa K, Saiwai H, Yokota K, Kubota K, Hayashi T, Morishita Y, Masuda M, Sakai H, Kawano O, Nakashima Y, Maeda T. Verification of the Accuracy of Cervical Spinal Cord Injury Prognosis Prediction Using Clinical Data-Based Artificial Neural Networks. J Clin Med 2024; 13:253. [PMID: 38202260 PMCID: PMC10779821 DOI: 10.3390/jcm13010253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/19/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND In patients with cervical spinal cord injury (SCI), we need to make accurate prognostic predictions in the acute phase for more effective rehabilitation. We hypothesized that a multivariate prognosis would be useful for patients with cervical SCI. METHODS We made two predictive models using Multiple Linear Regression (MLR) and Artificial Neural Networks (ANNs). We adopted MLR as a conventional predictive model. Both models were created using the same 20 clinical parameters of the acute phase data at the time of admission. The prediction results were classified by the ASIA Impairment Scale. The training data consisted of 60 cases, and prognosis prediction was performed for 20 future cases (test cohort). All patients were treated in the Spinal Injuries Center (SIC) in Fukuoka, Japan. RESULTS A total of 16 out of 20 cases were predictable. The correct answer rate of MLR was 31.3%, while the rate of ANNs was 75.0% (number of correct answers: 12). CONCLUSION We were able to predict the prognosis of patients with cervical SCI from acute clinical data using ANNs. Performing effective rehabilitation based on this prediction will improve the patient's quality of life after discharge. Although there is room for improvement, ANNs are useful as a prognostic tool for patients with cervical SCI.
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Affiliation(s)
- Jun Kishikawa
- Department of Orthopedic Surgery, Spinal Injuries Center, Fukuoka 820-8508, Japan; (J.K.); (K.Y.); (K.K.); (T.H.); (Y.M.); (M.M.); (H.S.); (O.K.); (T.M.)
- Department of Orthopedic Surgery, Kyushu University, Fukuoka 812-8582, Japan; (H.S.); (Y.N.)
| | - Kazu Kobayakawa
- Department of Orthopedic Surgery, Kyushu University, Fukuoka 812-8582, Japan; (H.S.); (Y.N.)
| | - Hirokazu Saiwai
- Department of Orthopedic Surgery, Kyushu University, Fukuoka 812-8582, Japan; (H.S.); (Y.N.)
| | - Kazuya Yokota
- Department of Orthopedic Surgery, Spinal Injuries Center, Fukuoka 820-8508, Japan; (J.K.); (K.Y.); (K.K.); (T.H.); (Y.M.); (M.M.); (H.S.); (O.K.); (T.M.)
| | - Kensuke Kubota
- Department of Orthopedic Surgery, Spinal Injuries Center, Fukuoka 820-8508, Japan; (J.K.); (K.Y.); (K.K.); (T.H.); (Y.M.); (M.M.); (H.S.); (O.K.); (T.M.)
| | - Tetsuo Hayashi
- Department of Orthopedic Surgery, Spinal Injuries Center, Fukuoka 820-8508, Japan; (J.K.); (K.Y.); (K.K.); (T.H.); (Y.M.); (M.M.); (H.S.); (O.K.); (T.M.)
| | - Yuichiro Morishita
- Department of Orthopedic Surgery, Spinal Injuries Center, Fukuoka 820-8508, Japan; (J.K.); (K.Y.); (K.K.); (T.H.); (Y.M.); (M.M.); (H.S.); (O.K.); (T.M.)
| | - Muneaki Masuda
- Department of Orthopedic Surgery, Spinal Injuries Center, Fukuoka 820-8508, Japan; (J.K.); (K.Y.); (K.K.); (T.H.); (Y.M.); (M.M.); (H.S.); (O.K.); (T.M.)
| | - Hiroaki Sakai
- Department of Orthopedic Surgery, Spinal Injuries Center, Fukuoka 820-8508, Japan; (J.K.); (K.Y.); (K.K.); (T.H.); (Y.M.); (M.M.); (H.S.); (O.K.); (T.M.)
| | - Osamu Kawano
- Department of Orthopedic Surgery, Spinal Injuries Center, Fukuoka 820-8508, Japan; (J.K.); (K.Y.); (K.K.); (T.H.); (Y.M.); (M.M.); (H.S.); (O.K.); (T.M.)
| | - Yasuharu Nakashima
- Department of Orthopedic Surgery, Kyushu University, Fukuoka 812-8582, Japan; (H.S.); (Y.N.)
| | - Takeshi Maeda
- Department of Orthopedic Surgery, Spinal Injuries Center, Fukuoka 820-8508, Japan; (J.K.); (K.Y.); (K.K.); (T.H.); (Y.M.); (M.M.); (H.S.); (O.K.); (T.M.)
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7
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Kadambi A, Bandini A, Ramkalawan RD, Hitzig SL, Zariffa J. Designing an Egocentric Video-Based Dashboard to Report Hand Performance Measures for Outpatient Rehabilitation of Cervical Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2023; 29:75-87. [PMID: 38174134 PMCID: PMC10759816 DOI: 10.46292/sci23-00015s] [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: 01/05/2024]
Abstract
Background Functional use of the upper extremities (UEs) is a top recovery priority for individuals with cervical spinal cord injury (cSCI), but the inability to monitor recovery at home and limitations in hand function outcome measures impede optimal recovery. Objectives We developed a framework using wearable cameras to monitor hand use at home and aimed to identify the best way to report information to clinicians. Methods A dashboard was iteratively developed with clinician (n = 7) input through focus groups and interviews, creating low-fidelity prototypes based on recurring feedback until no new information emerged. Affinity diagramming was used to identify themes and subthemes from interview data. User stories were developed and mapped to specific features to create a high-fidelity prototype. Results Useful elements identified for a dashboard reporting hand performance included summaries to interpret graphs, a breakdown of hand posture and activity to provide context, video snippets to qualitatively view hand use at home, patient notes to understand patient satisfaction or struggles, and time series graphing of metrics to measure trends over time. Conclusion Involving end-users in the design process and breaking down user requirements into user stories helped identify necessary interface elements for reporting hand performance metrics to clinicians. Clinicians recognized the dashboard's potential to monitor rehabilitation progress, provide feedback on hand use, and track progress over time. Concerns were raised about the implementation into clinical practice, therefore further inquiry is needed to determine the tool's feasibility and usefulness in clinical practice for individuals with UE impairments.
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Affiliation(s)
- Adesh Kadambi
- KITE – Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Andrea Bandini
- KITE – Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, Pisa, Italy
- The Biorobotics Institute, Scuola Superiore Sant’Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Ryan D. Ramkalawan
- KITE – Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Sander L. Hitzig
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - José Zariffa
- KITE – Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Edward S. Rogers Sr. Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada
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8
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Siegel BH, Wu J, Dubon M. The use of an ice cube to assess spinothalamic tract integrity in pediatric patients with spinal cord injury. PM R 2023; 15:1064-1065. [PMID: 36565441 DOI: 10.1002/pmrj.12933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/16/2022] [Accepted: 12/02/2022] [Indexed: 12/25/2022]
Affiliation(s)
- Becky H Siegel
- Orthopedics and Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer Wu
- Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mary Dubon
- Orthopedics and Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
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9
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Kamal R, Verma H, Narasimhaiah S, Chopra S. Predicting the Role of Preoperative Intramedullary Lesion Length and Early Decompressive Surgery in ASIA Impairment Scale Grade Improvement Following Subaxial Traumatic Cervical Spinal Cord Injury. J Neurol Surg A Cent Eur Neurosurg 2023; 84:144-156. [PMID: 35668673 PMCID: PMC9977512 DOI: 10.1055/s-0041-1740379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 09/15/2021] [Indexed: 10/18/2022]
Abstract
BACKGROUND Traumatic cervical spinal cord injury (TCSCI) is a disabling condition with uncertain neurologic recovery. Clinical and preclinical studies have suggested early surgical decompression and other measures of neuroprotection improve neurologic outcome. We investigated the role of intramedullary lesion length (IMLL) on preoperative magnetic resonance imaging (MRI) and the effect of early cervical decompressive surgery on ASIA impairment scale (AIS) grade improvement following TCSCI. METHODS In this retrospective study, we investigated 34 TCSCI patients who were admitted over a 12-year period, from January 1, 2008 to January 31, 2020. We studied the patient demographics, mode of injury, IMLL and timing of surgical decompression. The IMLL is defined as the total length of edema and contusion/hemorrhage within the cord. Short tau inversion recovery (STIR) sequences or T2-weighted MR imaging with fat saturation increases the clarity of edema and depicts abnormalities in the spinal cord. All patients included had confirmed adequate spinal cord decompression with cervical fixation and a follow-up of at least 6 months. RESULTS Of the 34 patients, 16 patients were operated on within 24 hours (early surgery group) and 18 patients were operated on more than 24 hours after trauma (delayed surgery group). In the early surgery group, 13 (81.3%) patients had improvement of at least one AIS grade, whereas in the delayed surgery group, AIS grade improvement was seen in only in 8 (44.5%) patients (early vs. late surgery; odds ratio [OR] = 1.828; 95% confidence interval [CI]: 1.036-3.225). In multivariate regression analysis coefficients, the timing of surgery and intramedullary edema length on MRI were the most significant factors in improving the AIS grade following cervical SCI. Timing of surgery as a unique variance predicted AIS grade improvement significantly (p < 0.001). The mean IMLL was 41.47 mm (standard deviation [SD]: 18.35; range: 20-87 mm). IMLL was a predictor of AIS grade improvement on long-term outcome in bivariate analysis (p < 0.001). This study suggests that patients who had IMLL of less than 30 mm had a better chance of grade conversion irrespective of the timing of surgery. Patients with an IMLL of 31 to 60 mm had chances of better grade conversion after early surgery. A longer IMLL predicts lack of improvement (p < 0.05). If the IMLL is greater than 61 mm, the probability of nonconversion of AIS grade is higher, even if the patient is operated on within 24 hours of trauma. CONCLUSION Surgical decompression within 24 hours of trauma and shorter preoperative IMLL are significantly associated with improved neurologic outcome, reflected by better AIS grade improvement at 6 months' follow-up. The IMLL on preoperative MRI can reliably predict outcome after 6 months. The present study suggests that patients have lesser chances of AIS grade improvement when the IMLL is ≥61 mm.
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Affiliation(s)
- Raj Kamal
- Department of Neurosurgery, Escorts Hospital, Amritsar, Punjab, India
| | - Himanshu Verma
- Department of Neurosurgery, Escorts Hospital, Amritsar, Punjab, India
| | | | - Suruchi Chopra
- Department of Radiology, Escorts Hospital, Amritsar, Punjab, India
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10
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Zou Z, Kang S, Hou Y, Chen K. Pediatric spinal cord injury with radiographic abnormality: the Beijing experience. Spine J 2023; 23:403-411. [PMID: 36064092 DOI: 10.1016/j.spinee.2022.08.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spinal cord injury (SCI) without radiographic abnormality (SCIWORA) is a syndrome that usually occurs in children primarily because of the unique biomechanics of the pediatric spine. We recently found that the histopathological and behavioral effects of SCI with radiographic abnormality (SCIWRA) and SCIWORA are very different from each other in animal models. Although numerous studies were conducted to understand the epidemiological and clinical characteristics of the overall pediatric SCI population and the pediatric SCIWORA population, the characteristics of the pediatric SCIWRA population and their differences from those of the SCIWORA population are poorly understood. PURPOSE To describe the epidemiology and clinical outcomes of pediatric patients with SCIWRA and their differences from those with SCIWORA. STUDY DESIGN/SETTING Retrospective study. PATIENT SAMPLE A total of 47 pediatric SCIWRA patients. OUTCOME MEASURES Epidemiological characteristics, injury severities, functional deficits, and management and recovery outcomes. METHODS Review of all cases with SCIWRA at Beijing Children's Hospital between July 2007 and December 2019 and comparison between the present data and our previous SCIWORA data. RESULTS Of the 187 pediatric SCI patients, 47 had SCIWRA (age: 7.06 ± 3.75 years, male-to-female ratio: 3:2). Main causes of SCIWRA were fall (38%) and traffic accidents (38%). Lesions were often located at multiple levels (62%). Incubation period was 3 ± 18 hours. According to the American Spinal Injury Association impairment scale (AIS), many SCIWRA patients had incomplete impairment (AIS B, 9%; AIS C, 9%; AIS D, 32%). Specifically, many of them had abnormal upper and lower limb muscle powers (55% and 60%), upper and lower limb muscle tones (34% and 49%), sensation (38%), and knee, ankle, and abdominal reflexes (47%, 34%, and 36%). 72% of SCIWRA patients were treated with methylprednisolone, dexamethasone, or both. 81% of them showed neurological improvement before discharge. There was no association between corticosteroid therapy and neurological improvement. Moreover, functional outcomes of their upper and lower limb muscle powers were significantly associated with functional outcomes of their upper and lower limb muscle tones (p < 0.01), respectively. In comparison to the SCIWRA population, the SCIWORA population had a higher ratio of younger and female patients of sports-related thoracic injuries with long incubation period leading to lower-body deficits and complete impairment (p<0.05 or p<0.01). Despite all the differences, their neurological improvement was similar (p>0.05). CONCLUSIONS Demographic differences exist in the SCIWRA population. Corticosteroids do not appear to be effective in the different types of pediatric SCI. Limb muscle tone may be used to evaluate the functional status of limb muscle power. The epidemiological and clinical characteristics of SCIWRA and SCIWORA are very different from each other. It is important to formulate tailor-made prevention, evaluation, and management strategies for the pediatric population to optimize the SCI outcomes.
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Affiliation(s)
- Zhewei Zou
- Department of Neurology, Beijing Children's Hospital, 56 Nanlishi Road, Xicheng, Beijing, 100045, China
| | - Shaoyang Kang
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Yifu Science Hall, 37 Xueyuan Road, Haidian, Beijing, 100191, China
| | - Yuxin Hou
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Yifu Science Hall, 37 Xueyuan Road, Haidian, Beijing, 100191, China
| | - Kinon Chen
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Yifu Science Hall, 37 Xueyuan Road, Haidian, Beijing, 100191, China.
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11
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Koseki K, Takahashi K, Yamamoto S, Yoshikawa K, Abe A, Mutsuzaki H. Use of Robot-Assisted Ankle Training in a Patient with an Incomplete Spinal Cord Injury: A Case Report. J Funct Morphol Kinesiol 2023; 8:jfmk8010031. [PMID: 36976128 PMCID: PMC10054573 DOI: 10.3390/jfmk8010031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/24/2023] [Accepted: 02/24/2023] [Indexed: 03/29/2023] Open
Abstract
Rehabilitation interventions are crucial in promoting neuroplasticity after spinal cord injury (SCI). We provided rehabilitation with a single-joint hybrid assistive limb (HAL-SJ) ankle joint unit (HAL-T) in a patient with incomplete SCI. The patient had incomplete paraplegia and SCI (neurological injury height: L1, ASIA Impairment Scale: C, ASIA motor score (R/L) L4:0/0, S1:1/0) following a rupture fracture of the first lumbar vertebra. The HAL-T consisted of a combination of ankle plantar dorsiflexion exercises in the sitting position, knee flexion, and extension exercises in the standing position, and stepping exercises in the standing position with HAL assistance. The plantar dorsiflexion angles of the left and right ankle joints and electromyograms of the tibialis anterior and gastrocnemius muscles were measured and compared using a three-dimensional motion analyzer and surface electromyography before and after HAL-T intervention. Phasic electromyographic activity was developed in the left tibialis anterior muscle during plantar dorsiflexion of the ankle joint after the intervention. No changes were observed in the left and right ankle joint angles. We experienced a case in which intervention using HAL-SJ induced muscle potentials in a patient with a spinal cord injury who was unable to perform voluntary ankle movements due to severe motor-sensory dysfunction.
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Affiliation(s)
- Kazunori Koseki
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Inashiki-gun, Ibaraki 300-0331, Japan
| | - Kazushi Takahashi
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Inashiki-gun, Ibaraki 300-0331, Japan
| | - Satoshi Yamamoto
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Inashiki-gun, Ibaraki 300-0394, Japan
| | - Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Inashiki-gun, Ibaraki 300-0331, Japan
| | - Atsushi Abe
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Inashiki-gun, Ibaraki 300-0331, Japan
| | - Hirotaka Mutsuzaki
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, 4733 Ami, Inashiki-gun, Ibaraki 300-0331, Japan
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12
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Gouveia D, Cardoso A, Carvalho C, Almeida A, Gamboa Ó, Ferreira A, Martins Â. Approach to Small Animal Neurorehabilitation by Locomotor Training: An Update. Animals (Basel) 2022; 12:ani12243582. [PMID: 36552502 PMCID: PMC9774773 DOI: 10.3390/ani12243582] [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: 11/20/2022] [Revised: 12/05/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Neurorehabilitation has a wide range of therapies to achieve neural regeneration, reorganization, and repair (e.g., axon regeneration, remyelination, and restoration of spinal circuits and networks) to achieve ambulation for dogs and cats, especially for grade 1 (modified Frankel scale) with signs of spinal shock or grade 0 (deep pain negative), similar to humans classified with ASIA A lesions. This review aims to explain what locomotor training is, its importance, its feasibility within a clinical setting, and some possible protocols for motor recovery, achieving ambulation with coordinated and modulated movements. In addition, it cites some of the primary key points that must be present in the daily lives of veterinarians or rehabilitation nurses. These can be the guidelines to improve this exciting exercise necessary to achieve ambulation with quality of life. However, more research is essential in the future years.
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Affiliation(s)
- Débora Gouveia
- Arrábida Veterinary Hospital—Arrábida Animal Rehabilitation Center, 2925-538 Setubal, Portugal
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, 1950-396 Lisboa, Portugal
- Faculty of Veterinary Medicine, Lusófona University, Campo Grande, 1749-024 Lisboa, Portugal
- Correspondence:
| | - Ana Cardoso
- Arrábida Veterinary Hospital—Arrábida Animal Rehabilitation Center, 2925-538 Setubal, Portugal
| | - Carla Carvalho
- Arrábida Veterinary Hospital—Arrábida Animal Rehabilitation Center, 2925-538 Setubal, Portugal
| | - António Almeida
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal
| | - Óscar Gamboa
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal
| | - António Ferreira
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal
- CIISA—Centro Interdisciplinar-Investigaçāo em Saúde Animal, Faculdade de Medicina Veterinária, Av. Universi dade Técnica de Lisboa, 1300-477 Lisboa, Portugal
| | - Ângela Martins
- Arrábida Veterinary Hospital—Arrábida Animal Rehabilitation Center, 2925-538 Setubal, Portugal
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, 1950-396 Lisboa, Portugal
- Faculty of Veterinary Medicine, Lusófona University, Campo Grande, 1749-024 Lisboa, Portugal
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal
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13
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Bandini A, Dousty M, Hitzig SL, Craven BC, Kalsi-Ryan S, Zariffa J. Measuring Hand Use in the Home after Cervical Spinal Cord Injury Using Egocentric Video. J Neurotrauma 2022; 39:1697-1707. [PMID: 35747948 DOI: 10.1089/neu.2022.0156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Egocentric video has recently emerged as a potential solution for monitoring hand function in individuals living with tetraplegia in the community, especially for its ability to detect functional use in the home environment. The aim of this study was to develop and validate a wearable vision-based system for measuring hand use in the home among individuals living with tetraplegia. Several deep learning algorithms for detecting functional hand-object interactions were developed and compared. The most accurate algorithm was used to extract measures of hand function from 65 h of unscripted video recorded at home by 20 participants with tetraplegia. These measures were: the percentage of interaction time over total recording time (Perc); the average duration of individual interactions (Dur); and the number of interactions per hour (Num). To demonstrate the clinical validity of the technology, egocentric measures were correlated with validated clinical assessments of hand function and independence (Graded Redefined Assessment of Strength, Sensibility and Prehension [GRASSP], Upper Extremity Motor Score [UEMS], and Spinal Cord Independent Measure [SCIM]). Hand-object interactions were automatically detected with a median F1-score of 0.80 (0.67-0.87). Our results demonstrated that higher UEMS and better prehension were related to greater time spent interacting, whereas higher SCIM and better hand sensation resulted in a higher number of interactions performed during the egocentric video recordings. For the first time, measures of hand function automatically estimated in an unconstrained environment in individuals with tetraplegia have been validated against internationally accepted measures of hand function. Future work will necessitate a formal evaluation of the reliability and responsiveness of the egocentric-based performance measures for hand use.
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Affiliation(s)
- Andrea Bandini
- KITE Research Institute and Toronto, Ontario, Canada.,The BioRobotics Institute and Scuola Superiore Sant'Anna, Pisa, Italy.,Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Mehdy Dousty
- KITE Research Institute and Toronto, Ontario, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Sander L Hitzig
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Occupational Science and Occupational Therapy, and University of Toronto, Toronto, Ontario, Canada
| | - B Catharine Craven
- KITE Research Institute and Toronto, Ontario, Canada.,Brain and Spinal Cord Rehabilitation Program Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada.,Division of Physical Medicine and Rehabilitation Temerty Faculty of Medicine, and University of Toronto, Toronto, Ontario, Canada
| | - Sukhvinder Kalsi-Ryan
- KITE Research Institute and Toronto, Ontario, Canada.,Department of Physical Therapy and University of Toronto, Toronto, Ontario, Canada
| | - José Zariffa
- KITE Research Institute and Toronto, Ontario, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Edward S. Rogers Sr. Department of Electrical and Computer Engineering, University of Toronto, Toronto, Ontario, Canada
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14
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Javeed S, Greenberg JK, Zhang JK, Dibble CF, Khalifeh JM, Liu Y, Wilson TJ, Yang LJ, Park Y, Ray WZ. Derivation and Validation of a Clinical Prediction Rule for Upper Limb Functional Outcomes After Traumatic Cervical Spinal Cord Injury. JAMA Netw Open 2022; 5:e2247949. [PMID: 36542381 PMCID: PMC9857030 DOI: 10.1001/jamanetworkopen.2022.47949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Traumatic cervical spinal cord injury (SCI) can result in debilitating paralysis. Following cervical SCI, accurate early prediction of upper limb recovery can serve an important role in guiding the appropriateness and timing of reconstructive therapies. OBJECTIVE To develop a clinical prediction rule to prognosticate upper limb functional recovery after cervical SCI. DESIGN, SETTING, AND PARTICIPANTS This prognostic study was a retrospective review of a longitudinal cohort study including patients enrolled in the National SCI model systems (SCIMS) database in US. Eligible patients were 15 years or older with tetraplegia (neurological level of injury C1-C8, American Spinal Cord Injury Association [ASIA] impairment scale [AIS] A-D), with early (within 1 month of SCI) and late (1-year follow-up) clinical examinations from 2011 to 2016. The data analysis was conducted from September 2021 to June 2022. MAIN OUTCOMES AND MEASURES The primary outcome was a composite of dependency in eating, bladder management, transfers, and locomotion domains of functional independence measure at 1-year follow-up. Each domain ranges from 1 to 7 with a lower score indicating greater functional dependence. Composite dependency was defined as a score of 4 or higher in at least 3 chosen domains. Multivariable logistic regression was used to predict the outcome based on early neurological variables. Discrimination was quantified using C statistics, and model performance was internally validated with bootstrapping and 10-fold cross-validation. The performance of the prediction score was compared with AIS grading. Data were split into derivation (2011-2014) and temporal-validation (2015-2016) cohorts. RESULTS Among 2373 patients with traumatic cervical SCI, 940 had complete 1-year outcome data (237 patients [25%] aged 60 years or older; 753 men [80%]). The primary outcome was present in 118 patients (13%), which included 92 men (78%), 83 (70%) patients who were younger than 60 years, and 73 (62%) patients experiencing AIS grade A SCI. The variables significantly associated with the outcome were age (age 60 years or older: OR, 2.31; 95% CI, 1.26-4.19), sex (men: OR, 0.60; 95% CI, 0.31-1.17), light-touch sensation at C5 (OR, 0.44; 95% CI, 0.44-1.01) and C8 (OR, 036; 95% CI, 0.24-0.53) dermatomes, and motor scores of the elbow flexors (C5) (OR, 0.74; 95% CI, 0.60-0.89) and wrist extensors (C6) (OR, 0.61; 95% CI, 0.49-0.75). A multivariable model including these variables had excellent discrimination in distinguishing dependent from independent patients in the temporal-validation cohort (C statistic, 0.90; 95% CI, 0.88-0.93). A clinical prediction score (range, 0 to 45 points) was developed based on these measures, with higher scores increasing the probability of dependency. The discrimination of the prediction score was significantly higher than from AIS grading (change in AUC, 0.14; 95% CI, 0.10-0.18; P < .001). CONCLUSIONS AND RELEVANCE The findings of this study suggest that this prediction rule may help prognosticate upper limb function following cervical SCI. This tool can be used to set patient expectations, rehabilitation goals, and aid decision-making regarding the appropriateness and timing for upper limb reconstructive surgeries.
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Affiliation(s)
- Saad Javeed
- Department of Neurological Surgery, Washington University, St. Louis, Missouri
| | - Jacob K. Greenberg
- Department of Neurological Surgery, Washington University, St. Louis, Missouri
| | - Justin K. Zhang
- Department of Neurological Surgery, Washington University, St. Louis, Missouri
| | | | - Jawad M. Khalifeh
- Department of Neurological Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Ying Liu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Thomas J. Wilson
- Department of Neurosurgery, Stanford University, Stanford, California
| | - Lynda J. Yang
- Department of Neurological Surgery, University of Michigan School of Medicine, Ann Arbor
| | - Yikyung Park
- Department of Neurological Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Wilson Z. Ray
- Department of Neurological Surgery, Washington University, St. Louis, Missouri
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15
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Dietz N, Vaitheesh Jaganathan, Alkin V, Mettille J, Boakye M, Drazin D. Machine learning in clinical diagnosis, prognostication, and management of acute traumatic spinal cord injury (SCI): A systematic review. J Clin Orthop Trauma 2022; 35:102046. [PMID: 36425281 PMCID: PMC9678757 DOI: 10.1016/j.jcot.2022.102046] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/23/2022] [Accepted: 10/18/2022] [Indexed: 11/19/2022] Open
Abstract
Background Machine learning has been applied to improve diagnosis and prognostication of acute traumatic spinal cord injury. We investigate potential for clinical integration of machine learning in this patient population to navigate variability in injury and recovery. Materials and methods We performed a systematic review using PRISMA guidelines through PubMed database to identify studies that use machine learning algorithms for clinical application toward improvements in diagnosis, management, and predictive modeling. Results Of the 132 records identified, a total of 13 articles met inclusion criteria and were included in final analysis. Of the 13 articles, 5 focused on diagnostic accuracy and 8 were related to prognostication or management of traumatic spinal cord injury. Across studies, 1983 patients with spinal cord injury were evaluated with most classifying as ASIA C or D. Retrospective designs were used in 10 of 13 studies and 3 were prospective. Studies focused on MRI evaluation and segmentation for diagnostic accuracy and prognostication, investigation of mean arterial pressure in acute care and intraoperative settings, prediction of ambulatory and functional ability, chronic complication prevention, and psychological quality of life assessments. Decision tree, random forests (RF), support vector machines (SVM), hierarchical cluster tree analysis (HCTA), artificial neural networks (ANN), convolutional neural networks (CNN) machine learning subtypes were used. Conclusions Machine learning represents a platform technology with clinical application in traumatic spinal cord injury diagnosis, prognostication, management, rehabilitation, and risk prevention of chronic complications and mental illness. SVM models showed improved accuracy when compared to other ML subtypes surveyed. Inherent variability across patients with SCI offers unique opportunity for ML and personalized medicine to drive desired outcomes and assess risks in this patient population.
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Affiliation(s)
- Nicholas Dietz
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, Louisville, KY, 40202, USA
| | - Vaitheesh Jaganathan
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, Louisville, KY, 40202, USA
| | | | - Jersey Mettille
- Department of Anesthesia, University of Louisville, Louisville, KY, USA
| | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, 200 Abraham Flexner Hwy, Louisville, KY, 40202, USA
| | - Doniel Drazin
- Department of Neurosurgery, Providence Regional Medical Center Everett, Everett, WA, USA
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16
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Samejima S, Henderson R, Pradarelli J, Mondello SE, Moritz CT. Activity-dependent plasticity and spinal cord stimulation for motor recovery following spinal cord injury. Exp Neurol 2022; 357:114178. [PMID: 35878817 DOI: 10.1016/j.expneurol.2022.114178] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/22/2022] [Accepted: 07/16/2022] [Indexed: 02/07/2023]
Abstract
Spinal cord injuries lead to permanent physical impairment despite most often being anatomically incomplete disruptions of the spinal cord. Remaining connections between the brain and spinal cord create the potential for inducing neural plasticity to improve sensorimotor function, even many years after injury. This narrative review provides an overview of the current evidence for spontaneous motor recovery, activity-dependent plasticity, and interventions for restoring motor control to residual brain and spinal cord networks via spinal cord stimulation. In addition to open-loop spinal cord stimulation to promote long-term neuroplasticity, we also review a more targeted approach: closed-loop stimulation. Lastly, we review mechanisms of spinal cord neuromodulation to promote sensorimotor recovery, with the goal of advancing the field of rehabilitation for physical impairments following spinal cord injury.
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Affiliation(s)
- Soshi Samejima
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Richard Henderson
- Department of Electrical and Computer Engineering, University of Washington, Seattle, WA, USA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Jared Pradarelli
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Sarah E Mondello
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Chet T Moritz
- Department of Electrical and Computer Engineering, University of Washington, Seattle, WA, USA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA; Center for Neurotechnology, Seattle, WA, USA; Department of Physiology and Biophysics, University of Washington, Seattle, WA, USA.
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17
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Nori S, Watanabe K, Takeda K, Yamane J, Kono H, Yokogawa N, Sasagawa T, Ando K, Nakashima H, Segi N, Funayama T, Eto F, Yamaji A, Furuya T, Yunde A, Nakajima H, Yamada T, Hasegawa T, Terashima Y, Hirota R, Suzuki H, Imajo Y, Ikegami S, Uehara M, Tonomura H, Sakata M, Hashimoto K, Onoda Y, Kawaguchi K, Haruta Y, Suzuki N, Kato K, Uei H, Sawada H, Nakanishi K, Misaki K, Terai H, Tamai K, Shirasawa E, Inoue G, Kiyasu K, Iizuka Y, Takasawa E, Funao H, Kaito T, Yoshii T, Ishihara M, Okada S, Imagama S, Kato S. Does surgery improve neurological outcomes in older individuals with cervical spinal cord injury without bone injury? A multicenter study. Spinal Cord 2022; 60:895-902. [PMID: 35690640 DOI: 10.1038/s41393-022-00818-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective multicenter study. OBJECTIVES To investigate the neurological outcomes of older individuals treated with surgery versus conservative treatment for cervical spinal cord injury (CSCI) without bone injury. SETTING Thirty-three medical institutions in Japan. METHODS This study included 317 consecutive persons aged ≥65 years with CSCI without bone injury in participating institutes between 2010 and 2020. The participants were followed up for at least 6 months after the injury. Individuals were divided into surgery (n = 114) and conservative treatment (n = 203) groups. To compare neurological outcomes and complications between the groups, propensity score matching of the baseline factors (characteristics, comorbidities, and neurological function) was performed. RESULTS After propensity score matching, the surgery and conservative treatment groups comprised 89 individuals each. Surgery was performed at a median of 9.0 (3-17) days after CSCI. Baseline factors were comparable between groups, and the standardized difference in the covariates in the matched cohort was <10%. The American Spinal Injury Association (ASIA) impairment scale grade and ASIA motor score (AMS) 6 months after injury and changes in the AMS from baseline to 6 months after injury were not significantly different between groups (P = 0.63, P = 0.24, and P = 0.75, respectively). Few participants who underwent surgery demonstrated perioperative complications such as dural tear (1.1%), surgical site infection (2.2%), and C5 palsy (5.6%). CONCLUSION Conservative treatment is suggested to be a more favorable option for older individuals with CSCI without bone injuries, but this finding requires further validation.
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Affiliation(s)
- Satoshi Nori
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Kazuki Takeda
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, 8-2 Otemachi, Aoi-ku, Shizuoka, 420-0853, Japan
| | - Junichi Yamane
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Department of Orthopaedic Surgery, National Hospital Organization Murayama Medical Center, 2-37-1 Gakuen, Musashimurayama-shi, Tokyo, 208-0011, Japan
| | - Hitoshi Kono
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Keiyu Orthopedic Hospital, 2267 Akodacho, Tatebayashi-shi, Gunma, 374-0013, Japan
| | - Noriaki Yokogawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Takeshi Sasagawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.,Department of Orthopedics Surgery, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae, Toyama, Toyama, 930-8550, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Naoki Segi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Toru Funayama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Fumihiko Eto
- Department of Orthopaedic Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Akihiro Yamaji
- Department of Orthopaedic Surgery, Ibaraki Seinan Medical Center Hospital, 2190, Sakaimachi, Sashima, Ibaraki, 306-0433, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Graduate school of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Atsushi Yunde
- Department of Orthopaedic Surgery, Graduate school of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Hideaki Nakajima
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Tomohiro Yamada
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan.,Department of Orthopaedic Surgery, Nagoya Kyoritsu Hospital, 1-172 Hokke, Nakagawa-ku, Nagoya-shi, Aichi, 454-0933, Japan
| | - Tomohiko Hasegawa
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Yoshinori Terashima
- Department of Orthopaedic Surgery, Sapporo Medical University, South 1-West 16-291, Chuo-ku, Sapporo, 060-8543, Japan.,Department of Orthopaedic Surgery, Matsuda Orthopedic Memorial Hospital, North 18-East 4-1 Kita-ku, Sapporo, 001-0018, Japan
| | - Ryosuke Hirota
- Department of Orthopaedic Surgery, Sapporo Medical University, South 1-West 16-291, Chuo-ku, Sapporo, 060-8543, Japan
| | - Hidenori Suzuki
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube city, Yamaguchi, 755-8505, Japan
| | - Yasuaki Imajo
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube city, Yamaguchi, 755-8505, Japan
| | - Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Masashi Uehara
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hitoshi Tonomura
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Munehiro Sakata
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.,Department of Orthopaedics, Saiseikai Shiga Hospital, 2-4-1 Ohashi Ritto, Shiga, 520-3046, Japan
| | - Ko Hashimoto
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Yoshito Onoda
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Kenichi Kawaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yohei Haruta
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Nobuyuki Suzuki
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Kenji Kato
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Hiroshi Uei
- Department of Orthopaedic Surgery, Nihon University Hospital, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8393, Japan.,Department of Orthopaedic Surgery, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Hirokatsu Sawada
- Department of Orthopaedic Surgery, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Kazuo Nakanishi
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Kosuke Misaki
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Hidetomi Terai
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka-city, Osaka, 545-8585, Japan
| | - Koji Tamai
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka-city, Osaka, 545-8585, Japan
| | - Eiki Shirasawa
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Katsuhito Kiyasu
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, 783-8505, Japan
| | - Yoichi Iizuka
- Department of Orthopaedic Surgery, Gunma University, Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Eiji Takasawa
- Department of Orthopaedic Surgery, Gunma University, Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Haruki Funao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 852 Hatakeda, Narita, Chiba, 286-0124, Japan.,Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-0124, Japan.,Department of Orthopaedic Surgery and Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan
| | - Takashi Kaito
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaokal, Suita, Osaka, 565-0871, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Masayuki Ishihara
- Department of Orthopaedic Surgery, Kansai Medical University Hospital, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan
| | - Seiji Okada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaokal, Suita, Osaka, 565-0871, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Satoshi Kato
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
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18
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Kiang L, Woodington B, Carnicer-Lombarte A, Malliaras G, Barone DG. Spinal cord bioelectronic interfaces: opportunities in neural recording and clinical challenges. J Neural Eng 2022; 19. [PMID: 35320780 DOI: 10.1088/1741-2552/ac605f] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/23/2022] [Indexed: 11/11/2022]
Abstract
Bioelectronic stimulation of the spinal cord has demonstrated significant progress in restoration of motor function in spinal cord injury (SCI). The proximal, uninjured spinal cord presents a viable target for the recording and generation of control signals to drive targeted stimulation. Signals have been directly recorded from the spinal cord in behaving animals and correlated with limb kinematics. Advances in flexible materials, electrode impedance and signal analysis will allow SCR to be used in next-generation neuroprosthetics. In this review, we summarize the technological advances enabling progress in SCR and describe systematically the clinical challenges facing spinal cord bioelectronic interfaces and potential solutions, from device manufacture, surgical implantation to chronic effects of foreign body reaction and stress-strain mismatches between electrodes and neural tissue. Finally, we establish our vision of bi-directional closed-loop spinal cord bioelectronic bypass interfaces that enable the communication of disrupted sensory signals and restoration of motor function in SCI.
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Affiliation(s)
- Lei Kiang
- Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, Singapore, 169608, SINGAPORE
| | - Ben Woodington
- Department of Engineering, University of Cambridge, Electrical Engineering Division, 9 JJ Thomson Ave, Cambridge, Cambridge, CB2 1TN, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Alejandro Carnicer-Lombarte
- Clinical Neurosciences, University of Cambridge, Bioelectronics Laboratory, Cambridge, CB2 0PY, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - George Malliaras
- University of Cambridge, University of Cambridge, Cambridge, CB2 1TN, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Damiano G Barone
- Department of Engineering, University of Cambridge, Electrical Engineering Division, 9 JJ Thomson Ave, Cambridge, Cambridge, Cambridgeshire, CB2 1TN, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
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19
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Lee SW, Lim KB, Kim J, Lee H, Kim HS, Yoo J. Concordance between the international standards for neurological classification of spinal cord injury motor examination and needle electromyography findings in muscles with a motor power grade of zero or trace. J Spinal Cord Med 2022; 46:433-440. [PMID: 35007492 PMCID: PMC10114965 DOI: 10.1080/10790268.2021.2021044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
CONTEXT/OBJECTIVE To evaluate the accuracy of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) motor examination in individuals with spinal cord injury (SCI) with motor grade 0 or 1 and analyze its degree of concordance with needle electromyography (EMG) findings for each key muscle. DESIGN Retrospective study. SETTING University hospital in Goyang, Korea. PARTICIPANTS Individuals with SCI admitted to the Department of Rehabilitation from January 2013 to June 2019. INTERVENTIONS In the enrolled persons, needle EMG was performed on muscles with motor grade 0 or 1 on ISNCSCI examination, and muscle contraction was confirmed through the detection of motor unit action potential. OUTCOME MEASURES The agreement between motor examination and needle EMG findings was analyzed. RESULTS In 175 key muscles, needle EMG findings in 115 and 60 muscles evaluated as grades 0 and 1 on ISNCSCI examination showed 80% and 50% agreements, respectively. We found a fair agreement between motor examination and needle EMG findings (κ = 0.309, P < 0.0001). Moreover, statistically significant agreement was seen only in T1, L2, and S1 key muscles (κ = 1, P < 0.0001; κ = 0.359, P = 0.019; and κ = 0.521, P = 0.004, respectively). CONCLUSIONS It is important to accurately distinguish between grade 0 and 1 motor power to maximize the positive outcomes from rehabilitation treatment and predict the possibility of recovery in individuals with SCI. Therefore, to improve the accuracy of motor examination and the American Spinal Injury Association Impairment Scale, needle EMG confirmation could be considered for muscles with motor grade 0 or 1 in individuals with SCI.
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Affiliation(s)
- Sang Wan Lee
- Department of Physical Medicine and Rehabilitation, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea
| | - Kil-Byung Lim
- Department of Physical Medicine and Rehabilitation, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea
| | - Jiyong Kim
- Department of Physical Medicine and Rehabilitation, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea
| | - Hojin Lee
- Department of Physical Medicine and Rehabilitation, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea
| | - Ha Seong Kim
- Department of Physical Medicine and Rehabilitation, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea
| | - Jeehyun Yoo
- Department of Physical Medicine and Rehabilitation, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea
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20
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Shea C, Slocum C, Goldstein R, Roach MJ, Griffin R, Chen Y, Zafonte R. Trauma Indicators in Spinal Cord Injury Rehabilitation Outcomes: A Retrospective Cohort Analysis of the National Trauma Data Bank and National Spinal Cord Injury Database. Arch Phys Med Rehabil 2021; 103:642-648.e2. [PMID: 34936887 DOI: 10.1016/j.apmr.2021.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/05/2021] [Accepted: 12/08/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate whether initial emergency room physiologic measures and metrics of trauma severity predict functional outcomes and neurologic recovery in traumatic spinal cord injury. DESIGN Retrospective analysis of a clinical database. SETTING Merged multi-center data from the Spinal Cord Injury Model Systems (SCIMS) database and National Trauma Data Bank (NTDB) from six academic medical centers across the United States. PARTICIPANTS 319 patients admitted to SCIMS rehabilitation centers within one-year of injury. The majority of patients were male (76.2%), with a mean age of 44 (SD 19). At rehabilitation admission, the most common neurologic level of injury was low cervical (C5-C8, 39.5%) and ASIA impairment scale (AIS) was A (34.4%). MAIN OUTCOME MEASURES(S) Primary outcomes were (1) Functional Independence Measure (FIM) motor score at discharge from inpatient rehabilitation and (2) change in FIM motor score between inpatient rehabilitation admission and discharge. We hypothesized that derangements in emergency room physiologic measures, such as decreased blood pressure and oxygen saturation, as well as increased severity of trauma burden, would predict poorer functional outcomes. RESULTS Linear regression analysis showed that neurologic level of injury and AIS predicted discharge FIM motor score. Systolic blood pressure, heart rate, oxygen saturation, need for assisted respiration, and presence of penetrating injury did not predict discharge motor FIM or FIM motor score improvement. CONCLUSIONS Initial emergency room physiologic parameters did not prognosticate functional outcomes in this cohort.
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Affiliation(s)
- Cristina Shea
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA; Spaulding Rehabilitation Hospital, Charlestown, MA
| | - Chloe Slocum
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA; Spaulding Rehabilitation Hospital, Charlestown, MA.
| | - Richard Goldstein
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA; Spaulding Rehabilitation Hospital, Charlestown, MA
| | - Mary Joan Roach
- Case Western Reserve University School of Medicine, Cleveland, OH; MetroHealth Rehabilitation Institute, Cleveland, OH; Center for Health Research and Policy, Cleveland, OH
| | - Russell Griffin
- Trauma Care Delivery Research Unit, Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL; University of Alabama at Birmingham School of Public Health, Birmingham, AL
| | - Yuying Chen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA; Spaulding Rehabilitation Hospital, Charlestown, MA
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21
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Characterizing Natural Recovery of People With Initial Motor Complete Tetraplegia. Arch Phys Med Rehabil 2021; 103:649-656. [PMID: 34800476 DOI: 10.1016/j.apmr.2021.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 08/02/2021] [Accepted: 09/17/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the differences in neurologic recovery in persons with initial cervical American Spinal Cord Injury Association Impairment Scale (AIS) grades A and B over time. DESIGN Retrospective analysis of data from people with traumatic cervical spinal cord injury (SCI) enrolled in the National Spinal Cord Injury Model Systems (SCIMS) database from 2011-2019. SETTING SCIMS centers. PARTICIPANTS Individuals (N=187) with traumatic cervical (C1-C7 motor level) SCI admitted with initial AIS grade A and B injuries within 30 days of injury, age 16 years or older, upper extremity motor score (UEMS) ≤20 on both sides, and complete neurologic data at admission and follow-up between 6 months and 2 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Conversion in AIS grades, UEMS and lower extremity motor scores (LEMS), and sensory scores. RESULTS Mean time to initial and follow-up examinations were 16.1±7.3 days and 377.5±93.4 days, respectively. Conversion from an initial cervical AIS grades A and B to motor incomplete status was 13.4% and 50.0%, respectively. The mean UEMS change for people with initial AIS grades A and B did not differ (7.8±6.5 and 8.8±6.1; P=.307), but people with AIS grade B experienced significantly higher means of LEMS change (2.3±7.4 and 8.8±13.9 (P≤.001). The increased rate of conversion to motor incomplete status from initial AIS grade B appears to be the primary driving factor of increased overall motor recovery. Individuals with initial AIS grade B had greater improvement in sensory scores. CONCLUSIONS While UEMS recovery is similar in persons with initial AIS grades A and B, the rate of conversion to motor incomplete status, LEMS, and sensory recovery are significantly different. This information is important for clinical as well as research considerations.
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22
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Bushkov FA, Razumov AN, Sichinava NV. [Patient-centered approach using COPM, GAS scores in medical rehabilitation of patients with tetraplegia after spinal cord injury]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOĬ FIZICHESKOĬ KULTURY 2021; 98:5-13. [PMID: 34719903 DOI: 10.17116/kurort2021980515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study the efficacy of the patient- and task-oriented approach and specific therapeutic exercises (TE) for the arms in patients after spinal cord injury at the cervical level. MATERIAL AND METHODS The study included 119 patients with a history of spinal injury of more than one year. They were divided into three demographically comparable groups. Group 1 patients (control) received standard of care: TE, physiotherapeutic treatment, social adaptation (SA), and massage; Group 2-standard of care and specific TE for the arms as part of the SA; Group 3-the same as Group 2 combined with the patient- and task-oriented approach (patient-selected activities were trained). Outcomes were assessed at the beginning (T1), end (T2), and at 1 year (T3) after a 30-day medical rehabilitation course. RESULTS No statistically significant differences between the groups in demographic, neurological (ISCSCI score), motor (FIMm, VLT scores), psychological parameters (depression, anxiety), quality of life (WHOQOL-BREF score) before the medical rehabilitation (T1) were observed. At the end of the medical rehabilitation course (T2), the increase in functional scores was 6.0±5.4 points of FIMm score, 6.0±4.6 points of VLT score in group 1; 8.0±7.6 points of FIMm score, 7.0±7.1 points of VLT score in group 2; 9.0±6.9 points of FIMm score, 8.0±7.6 points of VLT in group 3. Significant differences were found between groups 1 and 2 and 3 on the domains of «finger I» (13.6±9.64 points vs. 15.2±9.40 and 15.3±9.21 points respectively), «fingers II-V» (9.4±6.76 points vs. 11.3±6.41 and 11.6±6.76 points respectively) of VLT score; between groups 3 and 1 on the domains «self-care» (25.9±9.67 points vs. 23.1±9.8 points), «transfer» (11.7±6.21 points vs. 10.6±6.1 points) of the FIMm score, and also the group 3 patients had a higher quality of life by 3.0±1.8 points. At delayed follow-up (T3-T2), no changes of the FIMm and VLT scores were detected within groups. In group 3, 69% of problems were identified in self-care (COPM); subjective assessment of functional improvement for COPM (T2-T1) was as follows: «performance» 4.7±1.27 points, «satisfaction» 3.8±1.63 points; for GAS the T-score at the end of rehabilitation was 1.3±0.55 points, and the greatest significance of change was noted for COPM under «performance» (ES=0.73), with the correlation coefficient between FIMm and COPM being 0.55 and 0.63 for «performance» and «satisfaction» domains, respectively. CONCLUSION Patient- and task-oriented approach implemented by using COPM questionnaire and GAS score together with specific TE for arms is an effective method of motor medical rehabilitation of patients with posttraumatic cervical tetraplegia. This approach improves their quality of life, while parameters of subjective scores (COPM, GAS) have the same sensitivity in comparison with the conventional motor scores (FIMm, VLT).
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Affiliation(s)
- F A Bushkov
- Medical Rehabilitation Center «Preodolenie», Moscow, Russia
| | - A N Razumov
- Moscow Centre for Research Practice in Medical Rehabilitation, Restorative and Sports Medicine, Moscow, Russia
| | - N V Sichinava
- Moscow Centre for Research Practice in Medical Rehabilitation, Restorative and Sports Medicine, Moscow, Russia
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23
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Castanov V, Berger MJ, Ritsma B, Trier J, Hendry JM. Optimizing the timing of peripheral nerve transfers for functional re-animation in cervical spinal cord injury: a conceptual framework. J Neurotrauma 2021; 38:3365-3375. [PMID: 34715742 DOI: 10.1089/neu.2021.0247] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Loss of upper extremity function following spinal cord injury (SCI) can have devastating consequences on quality of life. Peripheral nerve transfer surgery aims to restore motor control of upper extremities following cervical SCI and is poised to revolutionize surgical management in this population. The surgery involves dividing an expendable donor nerve above the level of the spinal lesion and coapting it to a recipient nerve arising from the lesional or infralesional segment of the injured cord. In order to maximize outcomes in this complex patient population, refinements in surgical technique need to be integrated with principles of spinal cord medicine and basic science. Deciding on the ideal timing of nerve transfer surgery is one aspect of care that is critical to maximizing recovery and has received very little attention to date in the literature. This complex topic is reviewed, with a focus on expectations for spontaneous recovery within upper motor neuron components of the injury, balanced against the need for expeditious reinnervation for lower motor neuron elements of the injury. The discussion also considers the case of a patient with C6 motor complete SCI where myotomes without electrodiagnostic evidence of denervation spontaneously improved by 6 months post-injury, thereby adjusting the surgical plan. The relevant concepts are integrated into a clinical algorithm with recommendations that consider maximal opportunity for spontaneous clinical improvement post-injury while avoiding excessive delays that may adversely affect patient outcomes.
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Affiliation(s)
- Valera Castanov
- Queen's University, 4257, School of Medicine, Kingston, Ontario, Canada;
| | - Michael James Berger
- The University of British Columbia, 8166, Division of Physical Medicine and Rehabilitation, Vancouver, British Columbia, Canada.,The University of British Columbia, 8166, International Collaboration on Repair Discoveries, Vancouver, British Columbia, Canada;
| | - Benjamin Ritsma
- Queen's University, 4257, Department of Physical Medicine and Rehabilitation, Kingston, Ontario, Canada.,Providence Care Hospital, 4256, Kingston, Ontario, Canada;
| | - Jessica Trier
- Queen's University, 4257, Department of Physical Medicine and Rehabilitation, Kingston, Ontario, Canada.,Providence Care Hospital, 4256, Kingston, Ontario, Canada;
| | - J Michael Hendry
- Queen's University, 4257, School of Medicine, Kingston, Ontario, Canada.,Queen's University, 4257, Division of Plastic Surgery, Department of Surgery, Kingston, Ontario, Canada.,Kingston Health Sciences Centre, 71459, Kingston, Ontario, Canada;
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24
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Ramey WL, Reyes AA, Avila MJ, Hurlbert RJ, Chapman JR, Dumont TM. The Central Cord Score: A Novel Classification and Scoring System Specific to Acute Traumatic Central Cord Syndrome. World Neurosurg 2021; 156:e235-e242. [PMID: 34536617 DOI: 10.1016/j.wneu.2021.09.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Acute traumatic central cord syndrome (ATCCS) is the most common form of spinal cord injury in the United States. Treatment remains controversial, which is a consequence of ATCCS having an inherently different natural history from conventional spinal cord injury, thus requiring a separate classification system. We devised a novel Central Cord Score (CCscore), which both guides treatment and tracks improvement over time with symptoms specific to ATCCS. METHODS Medical records of patients with a diagnosis of ATCCS were retrospectively reviewed at a single institution. The CCscore was devised based on signs, symptoms, and imaging findings we believed to be critical in assessing severity of ATCCS. Numeric values were assigned for distal upper extremity motor strength, upper extremity sensation, ambulatory status, magnetic resonance imaging cord signal, and urinary retention. RESULTS We identified 51 patients with follow-up data; there were 17 cases of mild injury (CCscore 1-5), 23 moderate cases (CCscore 6-10), and 11 severe cases (CCscore 11-15). Patients treated surgically had significantly greater improvement in upper extremity motor scores and total CCscore only up to 3 months. In terms of timing of surgery, patients treated <24 hours after injury had significantly improved upper extremity motor scores and overall CCscores at last follow-up of ≥3 months. CONCLUSIONS Based on these data and their alignment with past literature, the CCscore is able to objectively and specifically categorize the severity and outcome of ATCCS, which represents a step forward in the quest to determine the ultimate efficacy and timing of surgery for ATCCS.
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Affiliation(s)
- Wyatt L Ramey
- Department of Neurosurgery, Banner University Medical Center - Tucson, Tucson, Arizona, USA.
| | - Angelica Alvarez Reyes
- Department of Neurosurgery, Banner University Medical Center - Tucson, Tucson, Arizona, USA
| | - Mauricio J Avila
- Department of Neurosurgery, Banner University Medical Center - Tucson, Tucson, Arizona, USA
| | - R John Hurlbert
- Department of Neurosurgery, Banner University Medical Center - Tucson, Tucson, Arizona, USA
| | - Jens R Chapman
- Department of Neurosurgery, Swedish Neuroscience Institute, Seattle, Washington, USA
| | - Travis M Dumont
- Department of Neurosurgery, Banner University Medical Center - Tucson, Tucson, Arizona, USA
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25
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Aguirre-Güemez AV, Mendoza-Muñoz M, Jiménez-Coello G, Rhoades-Torres GM, Pérez-Zavala R, Barrera-Ortíz A, Quinzaños-Fresnedo J. Nerve transfer rehabilitation in tetraplegia: Comprehensive assessment and treatment program to improve upper extremity function before and after nerve transfer surgery, a case report. J Spinal Cord Med 2021; 44:621-626. [PMID: 31525150 PMCID: PMC8288124 DOI: 10.1080/10790268.2019.1660841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
CONTEXT A 28-year-old male, sustained a traumatic Spinal Cord Injury (SCI) in January 2015, and was classified as AIS A, neurological level of injury (NLI) C4. As an inpatient at the SCI rehabilitation unit, he underwent multidisciplinary assessment involving SCI specialists, peripheral nerve surgeons, psychologists, occupational and physical therapists. Team consensus determined he was a candidate for nerve transfer surgery to improve upper extremity function. The patient undertook a pre-surgical neurorehabilitation program of 3 months duration. Surgery was performed bilaterally at 11 and 13 months after SCI (right and left arm respectively). FINDINGS Upon completion of surgical procedures, the patient underwent an intensive post-surgical rehabilitation program based on established goals, with follow-up every 3 months, up to 24 months after the surgery. Notable improvements were wheelchair propulsion, the ability to relieve pressure, grasp, pinch, and release an object. Standardized measures for SCI individuals (SCIM-III, CUE-Q, LiSAT-9 and UEMS) showed significant improvements. CLINICAL RELEVANCE Nerve transfers in tetraplegia are an underused technique. The benefits of surgery along with an intensive neurorehabilitation program, can improve independence and function in daily living activities for a properly selected group of individuals.
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Affiliation(s)
| | - Mario Mendoza-Muñoz
- Servicio de Cirugía de la Mano y Microcirugía, Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | - Gabriela Jiménez-Coello
- Médicos residentes de la especialidad de Medicina de Rehabilitación Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | - Gerald Martín Rhoades-Torres
- Médicos residentes de la especialidad de Medicina de Rehabilitación Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | - Ramiro Pérez-Zavala
- División de Rehabilitación Neurológica, Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | - Aida Barrera-Ortíz
- División de Rehabilitación Neurológica, Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | - Jimena Quinzaños-Fresnedo
- División de Rehabilitación Neurológica, Instituto Nacional de Rehabilitación, Mexico City, Mexico,Correspondence to: Jimena Quinzaños-Fresnedo, División de Rehabilitación Neurológica, Instituto Nacional de Rehabilitación, Avenida México-Xochimilco No. 289, Col. Arenal de Guadalupe, CP 14389, Delegación Tlalpan, México D.F.; Ph: 52(55)59991000, ext. 13410.
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26
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Zhong G, Yang Y, Huang X, Chen J, Feng D, Wei K, Chen J, Chen H. The Serum SIRT1 Protein is Associated with the Severity of Injury and Neurological Recovery in Mice with Traumatic Spinal Cord Injury. Neuroscience 2021; 469:103-109. [PMID: 34171408 DOI: 10.1016/j.neuroscience.2021.06.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 02/07/2023]
Abstract
The present study aimed to investigate the association between the serum SIRT1 protein and the severity of spinal cord injury (SCI) as well as the neurological recovery in mice. In this study, the wild-type (WT), Mx1-Cre+ SIRT1loxP/loxP (Mx1), and LCK-Cre+SIRT1loxP/loxP (LCK) mice were subjected to sham surgery, mild, moderate, or severe SCI, respectively. The serum was collected at intervals of 12 h, 1 day (d), 3 d, 5 d, 7 d, 10 d, 14 d, and 21 d after the injury. The locomotor function of all the animals was assessed using the Basso mouse scale (BMS) and the serum SIRT1 proteins were analyzed using enzyme-linked immunosorbent assay (ELISA). The results demonstrated that about 7-10 d after SCI, the levels of SIRT1 protein in the serum correlated significantly with the severity of the injury and at 28 d post-injury, there was a distant neurological recovery (BMS score). The serum SIRT1 concentration in both the Mx1 and LCK mice in the sham group was significantly reduced compared to that in the WT mice, and there was a delayed increase in the serum SIRT1 levels after injury. These findings indicate that the SIRT1 concentrations in the serum of the SCI mice closely correlated with the acute severity and neurological outcome.
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Affiliation(s)
- Guibin Zhong
- Medical Department, Baoshan Branch Ren Ji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai 200444, China; Department of Orthopedics, Ren Ji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai 200127, China
| | - Yanqiu Yang
- Medical Department, Baoshan Branch Ren Ji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai 200444, China
| | - Xiaodong Huang
- Department of Orthopedics, The Third Affiliated Hospital of Guangzhou Medical University, Guangdong 510150, China
| | - Junling Chen
- Medical Department, Baoshan Branch Ren Ji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai 200444, China
| | - Daming Feng
- Medical Department, Baoshan Branch Ren Ji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai 200444, China
| | - Ke Wei
- Medical Department, Baoshan Branch Ren Ji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai 200444, China
| | - Jianwei Chen
- Department of Orthopedics, Ren Ji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai 200127, China.
| | - Haihong Chen
- Orthopedic Department, Minhang Center Hospital, Fudan University, Shanghai 201100, China.
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27
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Mahmoudi E, Lin P, Peterson MD, Meade MA, Tate DG, Kamdar N. Traumatic Spinal Cord Injury and Risk of Early and Late Onset Alzheimer's Disease and Related Dementia: Large Longitudinal Study. Arch Phys Med Rehabil 2021; 102:1147-1154. [PMID: 33508336 PMCID: PMC10536758 DOI: 10.1016/j.apmr.2020.12.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/12/2020] [Accepted: 12/20/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Traumatic spinal cord injury (TSCI) is a life altering event most often causing permanent physical disability. Little is known about the risk of developing Alzheimer disease and related dementia (ADRD) among middle-aged and older adults living with TSCI. Time to diagnosis of and adjusted hazard for ADRD was assessed. DESIGN Cohort study. SETTING Using 2007-2017 claims data from the Optum Clinformatics Data Mart, we identified adults (45+) with diagnosis of TSCI (n=7019). Adults without TSCI diagnosis were included as comparators (n=916,516). Using age, sex, race/ethnicity, cardiometabolic, psychological, and musculoskeletal chronic conditions, US Census division, and socioeconomic variables, we propensity score matched persons with and without TSCI (n=6083). Incidence estimates of ADRD were compared at 4 years of enrollment. Survival models were used to quantify unadjusted, fully adjusted, and propensity-matched unadjusted and adjusted hazard ratios (HRs) for incident ADRD. PARTICIPANTS Adults with and without TSCI (N=6083). INTERVENTION Not applicable. MAIN OUTCOMES MEASURES Diagnosis of ADRD. RESULTS Both middle-aged and older adults with TSCI had higher incident ADRD compared to those without TSCI (0.5% vs 0.2% and 11.7% vs 3.3% among 45-64 and 65+ y old unmatched cohorts, respectively) (0.5% vs 0.3% and 10.6% vs 6.2% among 45-64 and 65+ y old matched cohorts, respectively). Fully adjusted survival models indicated that adults with TSCI had a greater hazard for ADRD (among 45-64y old: unmatched HR: 3.19 [95% confidence interval, 95% CI, 2.30-4.44], matched HR: 1.93 [95% CI, 1.06-3.51]; among 65+ years old: unmatched HR: 1.90 [95% CI, 1.77-2.04], matched HR: 1.77 [1.55-2.02]). CONCLUSIONS Adults with TSCI are at a heightened risk for ADRD. Improved clinical screening and early interventions aiming to preserve cognitive function are of paramount importance for this patient cohort.
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Affiliation(s)
- Elham Mahmoudi
- Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI.
| | - Paul Lin
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Mark D Peterson
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Michelle A Meade
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Denise G Tate
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Neurosurgery, Michigan Medicine, University of Michigan, Ann Arbor, MI
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28
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Seelig J, Heller RA, Haubruck P, Sun Q, Georg Klingenberg J, Hackler J, Crowell HL, Daniel V, Moghaddam A, Schomburg L, Biglari B. Selenium-Binding Protein 1 (SELENBP1) as Biomarker for Adverse Clinical Outcome After Traumatic Spinal Cord Injury. Front Neurosci 2021; 15:680240. [PMID: 34140879 PMCID: PMC8204909 DOI: 10.3389/fnins.2021.680240] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/29/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Traumatic spinal cord injury (TSCI) presents a diagnostic challenge as it may have dramatic consequences for the affected patient. Additional biomarkers are needed for improved care and personalized therapy. Objective: Serum selenium binding protein 1 (SELENBP1) has been detected in myocardial infarction, reflecting hypoxic tissue damage and recovery odds. As SELENBP1 is usually not detected in the serum of healthy subjects, we tested the hypothesis that it may become detectable in TSCI and indicate tissue damage and regeneration odds. Methods: In this prospective observational study, patients with comparable injuries were allocated to three groups; vertebral body fractures without neurological impairment (control “C”), TSCI without remission (“G0”), and TSCI with signs of remission (“G1”). Consecutive serum samples were available from different time points and analyzed for SELENBP1 by sandwich immunoassay, for trace elements by X-ray fluorescence and for cytokines by multiplex immunoassays. Results: Serum SELENBP1 was elevated at admission in relation to the degree of neurological impairment [graded as A, B, C, or D according to the American Spinal Injury Association (AISA) impairment scale (AIS)]. Patients with the most severe neurological impairment (classified as AIS A) exhibited the highest SELENBP1 concentrations (p = 0.011). During the first 3 days, SELENBP1 levels differed between G0 and G1 (p = 0.019), and dynamics of SELENBP1 correlated to monocyte chemoattractant protein 1, chemokine ligand 3 and zinc concentrations. Conclusion: Circulating SELENBP1 concentrations are related to the degree of neurological impairment in TSCI and provide remission odds information. The tight correlation of SELENBP1 with CCL2 levels provides a novel link between Se metabolism and immune cell activation, with potential relevance for neurological damage and regeneration processes, respectively.
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Affiliation(s)
- Julian Seelig
- Institute for Experimental Endocrinology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Raban Arved Heller
- Institute for Experimental Endocrinology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,Heidelberg Trauma Research Group, Department of Trauma and Reconstructive Surgery, Centre for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany.,Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Patrick Haubruck
- Heidelberg Trauma Research Group, Department of Trauma and Reconstructive Surgery, Centre for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany.,Raymond Purves Bone and Joint Research Laboratories, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, St Leonards, NSW, Australia
| | - Qian Sun
- Institute for Experimental Endocrinology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Jochen Georg Klingenberg
- Institute for Experimental Endocrinology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Julian Hackler
- Institute for Experimental Endocrinology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Helena Lucia Crowell
- SIB Swiss Institute of Bioinformatics, University of Zurich, Zurich, Switzerland.,Systems Biology Ph.D. Program, Life Science Zurich Graduate School, ETH Zürich and University of Zurich, Zurich, Switzerland
| | - Volker Daniel
- Transplantation Immunology, Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Arash Moghaddam
- Aschaffenburg Trauma and Orthopaedic Research Group, Centre for Orthopaedics, Trauma Surgery and Sports Medicine, Hospital Aschaffenburg-Alzenau, Aschaffenburg, Germany
| | - Lutz Schomburg
- Institute for Experimental Endocrinology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Bahram Biglari
- Department of Paraplegiology, BG Trauma Centre Ludwigshafen, Ludwigshafen, Germany
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29
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Bandini A, Kalsi-Ryan S, Craven BC, Zariffa J, Hitzig SL. Perspectives and recommendations of individuals with tetraplegia regarding wearable cameras for monitoring hand function at home: Insights from a community-based study. J Spinal Cord Med 2021; 44:S173-S184. [PMID: 33960874 PMCID: PMC8604485 DOI: 10.1080/10790268.2021.1920787] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
CONTEXT Wearable cameras have great potential for producing novel outcome measures of upper limb (UL) function and guiding care in individuals with cervical spinal cord injury (cSCI) living in the community. However, little is known about the perspectives of individuals with cSCI on the potential adoption of this technology. OBJECTIVE To analyze feedback from individuals with cSCI regarding the use of wearable cameras to record daily activities at home, in order to define guidelines for improving the design of this technology and fostering its implementation to optimize UL rehabilitation. DESIGN Mixed-methods study. PARTICIPANTS Thirteen adults with cSCI C3-C8 AIS A-D impairment. MEASURES Interview including survey and semi-structured questions. RESULTS Participants felt that this technology can provide naturalistic information regarding hand use to clinicians and researchers, which in turn can lead to better assessments of UL function and optimized therapies. Participants described the technology as easy-to-use but often reported discomfort that prevented them from conducting long recordings of fully natural activities. Privacy concerns included the possibility to capture household members and personal information displayed on objects (e.g. smartphones). CONCLUSION We provide the first set of guidelines to help researchers and therapists understand which steps need to be taken to translate wearable cameras into outpatient care and community-based research for UL rehabilitation. These guidelines include miniaturized and easy-to-wear cameras, as well as multiple measures for preventing privacy concerns such as avoiding public spaces and providing control over the recordings (e.g. start and stop the recordings at any time, keep or delete a recording).
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Affiliation(s)
- Andrea Bandini
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network (UHN), Toronto, Ontario, Canada
| | - Sukhvinder Kalsi-Ryan
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network (UHN), Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - B. Catharine Craven
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network (UHN), Toronto, Ontario, Canada
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - José Zariffa
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network (UHN), Toronto, Ontario, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Edward S. Rogers Sr. Department of Electrical and Computer Engineering, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sander L. Hitzig
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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30
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Ramey WL, Chapman JR. Spinal Cord Injury Clinical Classification Systems: What Is Available and a Proposed Alternative. Neurosurg Clin N Am 2021; 32:333-340. [PMID: 34053721 DOI: 10.1016/j.nec.2021.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Spinal cord injury (SCI) remains a challenging disease in terms of surgical decision-making and improving neurologic outcome. As we have now entered a new era founded on routine "big data" capture, more advanced and meaningful yet simplified SCI classification systems and outcome measurement tools would be helpful to determine the efficacy of potential therapeutics in future clinical trials and registries. The proposed classification herein focuses on gross sensorimotor, sacral function below the injured level via an easy-to-use scoring system yielding grades 1 to 4 of injury severity. Such an optimized SCI scoring system would enhance real-time analytics and offer superior outcomes modeling.
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Affiliation(s)
- Wyatt L Ramey
- Department of Neurosurgery, Banner University of Arizona Medical Center - Tucson, PO Box 245070, 1501 North Campbell Avenue, Room 4303, Tucson, AZ 85724-5070, USA.
| | - Jens R Chapman
- Department of Neurosurgery, Swedish Neuroscience Institute, 550 17th Avenue, Seattle, WA 98122, USA
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31
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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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32
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Buri M, Tanadini LG, Hothorn T, Curt A. Unbiased Recursive Partitioning Enables Robust and Reliable Outcome Prediction in Acute Spinal Cord Injury. J Neurotrauma 2021; 39:266-276. [PMID: 33619988 DOI: 10.1089/neu.2020.7407] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Neurological disorders usually present very heterogeneous recovery patterns. Nonetheless, accurate prediction of future clinical end-points and robust definition of homogeneous cohorts are necessary for scientific investigation and targeted care. For this, unbiased recursive partitioning with conditional inference trees (URP-CTREE) have received increasing attention in medical research, especially, but not limited to traumatic spinal cord injuries (SCIs). URP-CTREE was introduced to SCI as a clinical guidance tool to explore and define homogeneous outcome groups by clinical means, while providing high accuracy in predicting future clinical outcomes. The validity and predictive value of URP-CTREE to provide improvements compared with other more common approaches applied by clinicians has recently come under critical scrutiny. Therefore, a comprehensive simulation study based on traumatic, cervical complete spinal cord injuries provides a framework to investigate and quantify the issues raised. First, we assessed the replicability and robustness of URP-CTREE to identify homogeneous subgroups. Second, we implemented a prediction performance comparison of URP-CTREE with traditional statistical techniques, such as linear or logistic regression, and a novel machine learning method. URP-CTREE's ability to identify homogeneous subgroups proved to be replicable and robust. In terms of prediction, URP-CTREE yielded a high prognostic performance comparable to a machine learning algorithm. The simulation study provides strong evidence for the robustness of URP-CTREE, which is achieved without compromising prediction accuracy. The slightly lower prediction performance is offset by URP-CTREE's straightforward interpretation and application in clinical settings based on simple, data-driven decision rules.
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Affiliation(s)
- Muriel Buri
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zürich, Switzerland
| | - Lorenzo G Tanadini
- School of Agricultural, Forest and Food Sciences, Bern University of Applied Sciences, Bern, Switzerland
| | - Torsten Hothorn
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zürich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zürich, Switzerland
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Bushkov FA, Romanovskaya EV, Usanova EV, Razumov AN, Sichinava NV. [Upper limb motor and functional recovery in patients with tetraplegia]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:47-52. [PMID: 33580761 DOI: 10.17116/jnevro202112101147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study the recovery of the upper limb motor function and functional independence in patients with cervical spinal cord injury. MATERIAL AND METHODS The study included 49 patients with subacute tetraplegia, mean age 33±14.8 years, 42 men and 7 women, admitted to the Preodolenie Rehabilitation Center. The follow-up was up to 2 years. The clinical and functional states were assessed after 3, 6, 12 and more than 12 months after spinal injury, using the ASIA neurological standard scale, the motor subscale of Functional Independence Scale (FIM) and short form of Van Lieshout Test (VLT). All patients received continuous rehabilitation courses that included physiotherapy, occupational therapy, social support, psychological rehabilitation. RESULTS Upper limb motor recovery occurred in the first 6 months after spinal cord injury at 5±3.9 points (ASIA), while in 49% patients motor level decreased by one segment of the spinal cord, in 8% patients completeness of spinal cord injury improved. The improvement of functional independence was found during the first 12 months: according to FIM, in the period of 3-6 months by 18±11.1 points, in the period of 6-12 months by 8±8.1 points; according to VLT in the period of 3-6 months by 19±14.4 points, in the period of 6-12 months by 5.6±6.02 points. CONCLUSIONS Upper limb motor recovery mostly occurs in the first 6 months while the functional independence improvement lasts during the first 12 months after a spinal cord injury.
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Affiliation(s)
- F A Bushkov
- Preodolenie Rehabilitation Center, Moscow, Russia
| | | | - E V Usanova
- Preodolenie Rehabilitation Center, Moscow, Russia
| | - A N Razumov
- Moscow Scientific and Practical Center for Medical Rehabilitation, Rehabilitation and Sports Medicine, Moscow, Russia
| | - N V Sichinava
- Moscow Scientific and Practical Center for Medical Rehabilitation, Rehabilitation and Sports Medicine, Moscow, Russia
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Slocum C, Shea C, Goldstein R, Zafonte R. Early Trauma Indicators and Rehabilitation Outcomes in Traumatic Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2021; 26:253-260. [PMID: 33536730 DOI: 10.46292/sci20-00017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objectives To investigate the relationship between early trauma indicators and neurologic recovery after traumatic SCI using standardized outcome measures from the ISNCSCI examination and standardized functional outcome measures for rehabilitation populations. Methods This is a retrospective review of merged, prospectively collected, multicenter data from the Spinal Cord Injury Model Systems (SCIMS) database and institutional trauma databases from five academic medical centers across the United States. Functional status at inpatient rehabilitation discharge and change in severity and level of injury from initial SCI to inpatient rehabilitation discharge were analyzed to assess neurologic recovery for patients with traumatic SCI. Linear and logistic regression with multiple imputation were used for the analyses. Results A total of 209 patients were identified. Mean age at injury was 47.2 ± 18.9 years, 72.4% were male, 22.4% of patients had complete injuries at presentation to the emergency department (ED), and most patients were admitted with cervical SCI. Mean systolic blood pressure (SBP) was 124.1 ± 29.6 mm Hg, mean ED heart rate was 83.7 ± 19.9 bpm, mean O2 saturation was 96.8% ± 4.0%, and mean Glasgow Coma Scale (GCS) score was 13.3 ± 3.9. The average Injury Severity Score (ISS) in this population was 22.4. Linear regression analyses showed that rehabilitation discharge motor FIM was predicted by motor FIM on admission and ISS. Requiring ventilatory support on ED presentation was negatively associated with improvement of ASIA Impairment Scale (AIS) grade at rehabilitation discharge compared with AIS grade after initial injury. Emergency room physiologic measures (SBP, pulse, oxygen saturation) did not predict discharge motor FIM or improvement in AIS grade or neurological level of injury. Conclusion Our study showed a positive association between discharge FIM and ISS and a negative association between ventilatory support at ED presentation and AIS improvement. The absence of any significant association between other physiologic or clinical variables at ED presentation with rehabilitation outcomes suggests important areas for future clinical research.
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Affiliation(s)
- Chloe Slocum
- Harvard Medical School, Boston, Massachusetts.,Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Cristina Shea
- Harvard Medical School, Boston, Massachusetts.,Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Richard Goldstein
- Harvard Medical School, Boston, Massachusetts.,Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Ross Zafonte
- Harvard Medical School, Boston, Massachusetts.,Spaulding Rehabilitation Hospital, Boston, Massachusetts
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Kalsi-Ryan S, Kapadia N, Gagnon DH, Verrier MC, Holmes J, Flett H, Farahani F, Alavinia SM, Omidvar M, Wiest MJ, Craven BC. Development of Reaching, Grasping & Manipulation indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project. J Spinal Cord Med 2021; 44:S134-S146. [PMID: 34779738 PMCID: PMC8604521 DOI: 10.1080/10790268.2021.1961052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To describe the development of structure, process, and outcome indicators aimed to advance the quality of Reaching, Grasping & Manipulation (RG&M) rehabilitation for Canadians living with spinal cord injury or disease (SCI/D). METHOD Upper extremity rehabilitation experts developed a framework of indicators for evaluation of RG&M rehabilitation quality. A systematic search of the literature identified potential upper extremity indicators that influence RG&M outcomes. A Driver diagram summarized factors influencing upper extremity outcomes to inform the selection of structure and process indicators. Psychometric properties, clinical utility, and feasibility of potential upper extremity measures were considered when selecting outcome indicators. RESULTS The selected structure indicator is the number of occupational and physical therapists with specialized certification, education, training and/or work experience in upper extremity therapy related to RG&M at a given SCI/D rehabilitation center. The process indicator is the total hours of upper extremity therapies related to RG&M and the proportion of this time allocated to neurorestorative therapy for each individual with tetraplegia receiving therapy. The outcome indicators are the Graded Redefined Assessment of Strength, Sensation and Prehension (GRASSP) strength and Spinal Cord Independence Measure III (SCIM III) Self-Care subscores implemented at rehabilitation admission and discharge, and SCIM III Self-Care subscore only at 18 months post-admission. CONCLUSION The selected indicators align with current practice, will direct the timing of routine assessments, and enhance the volume and quality of RG&M therapy delivered, with the aim to ultimately increase the proportion of individuals with tetraplegia achieving improved upper extremity function by 18 months post-rehabilitation.
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Affiliation(s)
- Sukhvinder Kalsi-Ryan
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Rocket Family Upper Extremity Clinic, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
| | - Naaz Kapadia
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Rocket Family Upper Extremity Clinic, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
- CRANIA, University Health Network and University of Toronto, Toronto, Canada
| | - Dany H. Gagnon
- School of Rehabilitation, Université de Montréal, Montreal, Québec, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain - CIUSSS du Centre-Sud-de-l’Ile-de-Montréal, Montreal, Québec, Canada
| | - Molly C. Verrier
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Holmes
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Heather Flett
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Farnoosh Farahani
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - S. Mohammad Alavinia
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Maryam Omidvar
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Matheus J. Wiest
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Ontario Neurotrauma Foundation, Toronto, Ontario, Canada
| | - B. Catharine Craven
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Bushkov FA, Razumov AN, Sichinava NV, Romanovskaya EV, Usanova EV. [Comparative analysis of functional independence predictors in patients with cervical tetraplegia]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOĬ FIZICHESKOĬ KULTURY 2020; 97:22-30. [PMID: 33054005 DOI: 10.17116/kurort20209705122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Purpose of the study was to investigate clinical predictors of functional independence in patients with cervical tetraplegia at different periods after a spinal cord injury (SCI). MATERIAL AND METHODS 190 patients (151 men and 39 women) with an SCI from 3 months to 6 years old were included in a retrospective study. The average age was 27 years. The examination was carried out using the international standard for neurological classification of spinal cord injury (ASIA) with the definition of motor score ASIA for the upper extremity (ASIA upper extremity), neurological (NL) and motor levels (ML), and the completeness of spinal cord injury (AIS). Functional assessment was performed using the FIM motor subscale. The study of neuromuscular conduction of the median nerves - according to stimulation electroneuromyography (SENMG). The degree of functional independence was assessed as a severe disability with FIM less than 42 points, mild and moderate - FIM 42 points or more. RESULTS Using logistic regression analysis, it was found that in the first 6 months after SCI, the main predictors are ASIAupper extremity (AUC=0.84; X2=3.32; p=0.06) and NL (AUC=0.80; X2=2.96; p=0.09). When observed in the first 12 months, ASIAupper extremity (AUC=0.86) remains the leading predictor. Moreover, pronounced functional limitations can be predicted using predictors of ASIAupper extremity in 84.4% and completeness of injury (AIS) in 81.2% of cases, moderate and mild limitations - ASIAupper extremity in 81.4%, NL in 86.0% and functional tenodesis (FT) in 100% of cases. In the long-term period (more than 12 months), the exceptional predictive power of the predictor ASIAupper extremity (AUC=0.92) is noted both in the prediction of severe (82.5%) cases and moderate and mild functional disorders (91.8% of cases). In addition, in the SCI long-term period, the predictor AIS plays a significant role in severe disorders (in 82.5% of cases), and NL (88.2%) and FT (100%) - in moderate and mild disorders. The boundaries between functional groups according to functional independence in groups of 12 months and more than 12 months after SMT are presented: ASIAupper extremity 22.4 and 22.6 points, ML more than 6.5 and the presence of FT with a ML of more than 5.6, respectively. At the same time, the results of SENMG showed low predictive significance. CONCLUSION Motor score ASIAupper extremity is a leading predictor in all periods after SCI, while completeness of spinal cord injury (AIS) more accurately predicts pronounced functional limitations, and ML and FT predict moderate functional limitations. The FT, a neurological level of C6 and higher, a motor score ASIA upper extremity of more than 22 points are criteria for achieving moderate functional independence.
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Affiliation(s)
- F A Bushkov
- Rehabilitation center «Overcoming», Moscow, Russia
| | - A N Razumov
- Moscow center for research and practice in medical, rehabilitation, restorative and sports medicine, Moscow, Russia
| | - N V Sichinava
- Moscow center for research and practice in medical, rehabilitation, restorative and sports medicine, Moscow, Russia
| | | | - E V Usanova
- Rehabilitation center «Overcoming», Moscow, Russia
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Shulga A, Savolainen S, Kirveskari E, Mäkelä JP. Enabling and promoting walking rehabilitation by paired associative stimulation after incomplete paraplegia: a case report. Spinal Cord Ser Cases 2020; 6:72. [PMID: 32792474 PMCID: PMC7426433 DOI: 10.1038/s41394-020-0320-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/23/2020] [Accepted: 07/28/2020] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Paired associative stimulation (PAS) is a combination of transcranial magnetic stimulation (TMS) and peripheral nerve stimulation (PNS) and induces plastic changes in the human corticospinal tract. We have previously shown that PAS consisting of TMS pulses given at 100% of stimulator output and high-frequency PNS is beneficial for motor rehabilitation of patients with a chronic incomplete spinal cord injury (SCI). The therapeutic possibilities of this PAS variant for walking rehabilitation of paraplegic patients are unexplored. CASE PRESENTATION A 47-year old man with traumatic incomplete paraplegia (AIS D, neurological level T7) received PAS to his left leg for 3 months at 12 months post injury (PAS1) and for an additional 3 months at 24 months post injury (PAS2). The right leg had normal AIS scores and was not stimulated. Before PAS, the patient was nonambulatory, could not stand without weight support, and was consequently not eligible for conventional walking rehabilitation. After PAS1, the patient could stand for 1.5 min and take 13 steps (24 steps in follow up) on parallel bars without weight support and was enrolled into conventional walking rehabilitation. He achieved independent walking ability with a rollator. During PAS2, walking distance increased 2.4 times faster than during the preceding year. The left leg AIS score and spinal cord independence measure mobility subscore increased. No adverse effects were detected. DISCUSSION This is the first report of PAS with a high-frequency peripheral component that enabled and promoted walking rehabilitation. Together with previous reports on this technique, this result encourages further research into its therapeutic potential and mechanism.
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Affiliation(s)
- A Shulga
- BioMag Laboratory, HUS Diagnostic Center, Helsinki University Hospital, Helsinki, Finland. .,Clinical Neurosciences, Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - S Savolainen
- BioMag Laboratory, HUS Diagnostic Center, Helsinki University Hospital, Helsinki, Finland
| | - E Kirveskari
- BioMag Laboratory, HUS Diagnostic Center, Helsinki University Hospital, Helsinki, Finland.,HUS Medical Imaging Center, Clinical Neurophysiology; Clinical Neurosciences, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - J P Mäkelä
- BioMag Laboratory, HUS Diagnostic Center, Helsinki University Hospital, Helsinki, Finland
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Bandini A, Dousty M, Zariffa J. A wearable vision-based system for detecting hand-object interactions in individuals with cervical spinal cord injury: First results in the home environment. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:2159-2162. [PMID: 33018434 DOI: 10.1109/embc44109.2020.9176274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Cervical spinal cord injury (cSCI) causes the paralysis of upper and lower limbs and trunk, significantly reducing quality of life and community participation of the affected individuals. The functional use of the upper limbs is the top recovery priority of people with cSCI and wearable vision-based systems have recently been proposed to extract objective outcome measures that reflect hand function in a natural context. However, previous studies were conducted in a controlled environment and may not be indicative of the actual hand use of people with cSCI living in the community. Thus, we propose a deep learning algorithm for automatically detecting hand-object interactions in egocentric videos recorded by participants with cSCI during their daily activities at home. The proposed approach is able to detect hand-object interactions with good accuracy (F1-score up to 0.82), demonstrating the feasibility of this system in uncontrolled situations (e.g., unscripted activities and variable illumination). This result paves the way for the development of an automated tool for measuring hand function in people with cSCI living in the community.
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Heinrichs ND, Kirby RL, Smith C, Russell KFJ, Theriault CJ, Doucette SP. Effect of seat height on manual wheelchair foot propulsion, a repeated-measures crossover study: part 2 - wheeling backward on a soft surface. Disabil Rehabil Assist Technol 2020; 17:325-330. [PMID: 32594783 DOI: 10.1080/17483107.2020.1782490] [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: 10/24/2022]
Abstract
Purpose: The aim of this study was to test the hypotheses that, during manual-wheelchair foot propulsion backward on a soft surface, lowering the seat height increases speed, push frequency and push effectiveness, and decreases perceived difficulty.Materials and methods: In a repeated-measures crossover study, 50 able-bodied participants used one foot to propel a manual wheelchair 5 m backward on a soft surface at 5 seat heights, ranging from 5.08 cm below to about 5.08 cm above lower-leg length, in random order. We recorded Wheelchair Skills Test (WST) capacity scores and used the Wheelchair Propulsion Test (WPT) to calculate speed (m/s), push frequency (cycles/s) and push effectiveness (m/cycle). We also recorded the participants' perceived difficulty (0-4) and video-recorded each trial.Results: WST capacity scores were reduced at the higher seat heights. Using repeated-measures models (adjusted for age, sex and order), there were negative relationships between seat height and speed (p < 0.0001) and push effectiveness (p < 0.0001). Lowering the seat height by 5.08 cm below lower-leg length corresponded to improvements in speed of 0.097 m/s and in push effectiveness of 0.101 m/cycle. The trend for push frequency was also significant (p = 0.035) but the effect size was smaller. Perceived difficulty increased with seat height (p < 0.0001). The video-recordings provided qualitative kinematic data regarding the seated "gait cycles".Conclusions: During manual-wheelchair foot propulsion backward on a soft surface, lowering the seat height increases speed and push effectiveness, and decreases perceived difficulty.IMPLICATIONS FOR REHABILITATIONBackward wheelchair foot propulsion on soft surfaces is affected by seat height.Speed (m/s) is improved if the seat height is lowered.Push effectiveness (m/gait cycle) is improved if the seat height is lowered.Perceived difficulty of propulsion is lower if the seat height is lowered.
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Affiliation(s)
- Nathaniel David Heinrichs
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Dalhousie University, Halifax, Canada
| | - Ronald Lee Kirby
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Dalhousie University, Halifax, Canada
| | - Cher Smith
- Department of Occupational Therapy, Nova Scotia Health Authority, Halifax, Canada
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Rodionov A, Savolainen S, Kirveskari E, Mäkelä JP, Shulga A. Effects of Long-Term Paired Associative Stimulation on Strength of Leg Muscles and Walking in Chronic Tetraplegia: A Proof-of-Concept Pilot Study. Front Neurol 2020; 11:397. [PMID: 32508738 PMCID: PMC7251052 DOI: 10.3389/fneur.2020.00397] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 04/17/2020] [Indexed: 01/22/2023] Open
Abstract
Recovery of lower-limb function after spinal cord injury (SCI) is dependent on the extent of remaining neural transmission in the corticospinal pathway. The aim of this proof-of-concept pilot study was to explore the effects of long-term paired associative stimulation (PAS) on leg muscle strength and walking in people with SCI. Five individuals with traumatic incomplete chronic tetraplegia (>34 months post-injury, motor incomplete, 3 females, mean age 60 years) with no contraindications to transcranial magnetic stimulation (TMS) received PAS to one or both legs for 2 months (28 sessions in total, 5 times a week for the first 2 weeks and 3 times a week thereafter). The participants were evaluated with the Manual Muscle Test (MMT), AIS motor and sensory examination, Modified Asworth Scale (MAS), and the Spinal Cord Independence Measure (SCIM) prior to the intervention, after 1 and 2 months of PAS, and after a 1-month follow-up. The study was registered at clinicaltrials.gov (NCT03459885). During the intervention, MMT scores and AIS motor scores increased significantly (p = 0.014 and p = 0.033, respectively). Improvements were stable in follow-up. AIS sensory scores, MAS, and SCIM were not modified significantly. MMT score prior to intervention was a good predictor of changes in walking speed (Radj2 = 0.962). The results of this proof-of-concept pilot study justify a larger trial on the effect of long-term PAS on leg muscle strength and walking in people with chronic incomplete SCI.
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Affiliation(s)
- Andrei Rodionov
- BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sarianna Savolainen
- BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Erika Kirveskari
- BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Clinical Neurosciences, Clinical Neurophysiology, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jyrki P Mäkelä
- BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anastasia Shulga
- BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Clinical Neurosciences, Neurology, Helsinki University Hospital, Helsinki, Finland
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Heinrichs ND, Kirby RL, Smith C, Russell KFJ, Theriault CJ, Doucette SP. Effect of seat height on manual wheelchair foot propulsion, a repeated-measures crossover study: part 1 - wheeling forward on a smooth level surface. Disabil Rehabil Assist Technol 2020; 16:831-839. [PMID: 32238086 DOI: 10.1080/17483107.2020.1741036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To test the hypotheses that, during manual wheelchair foot propulsion forward on smooth level surfaces, lowering the seat height increases speed, push frequency and push effectiveness, and decreases perceived difficulty.Materials and methods: In a repeated-measures crossover study, 50 able-bodied participants used one foot to propel a manual wheelchair 10 m on a smooth level surface at 5 seat heights in random order, ranging from 5.08 cm below to about 5.08 cm above lower-leg length. We recorded Wheelchair Skills Test (WST) capacity scores and used the Wheelchair Propulsion Test (WPT) to calculate speed (m/s), push frequency (cycles/s) and push effectiveness (m/cycle). We also recorded the participants' perceived difficulty (0-4) and video-recorded each trial.Results: WST capacity scores were reduced at the higher seat heights. Using repeated-measures models (adjusted for age, sex and order), there were negative relationships between seat height and speed (p < 0.0001) and push effectiveness (p < 0.0001). Lowering the seat height by 5.08 cm below lower-leg length corresponded to improvements in speed of 0.20 m/s and in push effectiveness of 0.20 m/cycle. The trend for push frequency was also significant (p = 0.003) but the effect size was smaller. Perceived difficulty increased with seat height (p < 0.001). The video-recordings provided qualitative kinematic data regarding the seated "gait cycles".Conclusions: During manual wheelchair foot propulsion forward on smooth level surfaces, lowering the seat height increases speed and push effectiveness, and decreases perceived difficulty.Clinical Trial Registration Number: NCT03330912.Implications for RehabilitationGenerally, wheelchairs used for forward foot propulsion should have a seat height that is 2.54-5.08 cm less than the sitting lower-leg length.Clinicians should, however, take into consideration other functions that may be adversely affected by lowering the seat height.
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Affiliation(s)
- Nathaniel David Heinrichs
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ronald Lee Kirby
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Cher Smith
- Department of Occupational Therapy, Nova Scotia Health Authority, Halifax, NS, Canada
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Yoo HJ, Lee S, Kim J, Park C, Lee B. Development of 3D-printed myoelectric hand orthosis for patients with spinal cord injury. J Neuroeng Rehabil 2019; 16:162. [PMID: 31888695 PMCID: PMC6937865 DOI: 10.1186/s12984-019-0633-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 12/12/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Spinal cord injury (SCI) is a severe medical condition affecting the hand and locomotor function. New medical technologies, including various wearable devices, as well as rehabilitation treatments are being developed to enhance hand function in patients with SCI. As three-dimensional (3D) printing has the advantage of being able to produce low-cost personalized devices, there is a growing appeal to apply this technology to rehabilitation equipment in conjunction with scientific advances. In this study, we proposed a novel 3D-printed hand orthosis that is controlled by electromyography (EMG) signals. The orthosis was designed to aid the grasping function for patients with cervical SCI. We applied this hand exoskeleton system to individuals with tetraplegia due to SCI and validated its effectiveness. METHODS The 3D architecture of the device was designed using computer-aided design software and printed with a polylactic acid filament. The dynamic hand orthosis enhanced the tenodesis grip to provide sufficient grasping function. The root mean square of the EMG signal was used as the input for controlling the device. Ten subjects with hand weakness due to chronic cervical SCI were enrolled in this study, and their hand function was assessed before and after wearing the orthosis. The Toronto Rehabilitation Institute Hand Function Test (TRI-HFT) was used as the primary outcome measure. Furthermore, improvements in functional independence in daily living and device usability were evaluated. RESULTS The newly developed orthosis improved hand function of subjects, as determined using the TRI-HFT (p < 0.05). Furthermore, participants obtained immediate functionality on eating after wearing the orthosis. Moreover, most participants were satisfied with the device as determined by the usability test. There were no side effects associated with the experiment. CONCLUSIONS The 3D-printed myoelectric hand orthosis was intuitive, easy to use, and showed positive effects in its ability to handle objects encountered in daily life. This study proved that combining simple EMG-based control strategies and 3D printing techniques was feasible and promising in rehabilitation engineering. TRIAL REGISTRATION Clinical Research Information Service (CRiS), Republic of Korea. KCT0003995. Registered 2 May 2019 - Retrospectively registered.
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Affiliation(s)
- Hyun-Joon Yoo
- Department of Biomedical Science and Engineering (BMSE), Institute Integrated Technology (IIT), Gwangju Institute of Science and Technology (GIST), 123 Cheomdan-gwagiro, Buk-gu, Gwangju, 61005 South Korea
| | - Sangbaek Lee
- Department of Biomedical Science and Engineering (BMSE), Institute Integrated Technology (IIT), Gwangju Institute of Science and Technology (GIST), 123 Cheomdan-gwagiro, Buk-gu, Gwangju, 61005 South Korea
| | - Jongheon Kim
- Department of Mechanical Engineering, Inha University, 100, Inha-ro, Michuhol-gu, Incheon, 22212 South Korea
| | - Chanki Park
- School of Mechanical Engineering, Gwangju Institute of Science and Technology (GIST), 123 Cheomdan-gwagiro, Buk-gu, Gwangju, 61005 South Korea
| | - Boreom Lee
- Department of Biomedical Science and Engineering (BMSE), Institute Integrated Technology (IIT), Gwangju Institute of Science and Technology (GIST), 123 Cheomdan-gwagiro, Buk-gu, Gwangju, 61005 South Korea
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The Role of Magnesium in the Secondary Phase After Traumatic Spinal Cord Injury. A Prospective Clinical Observer Study. Antioxidants (Basel) 2019; 8:antiox8110509. [PMID: 31653023 PMCID: PMC6912766 DOI: 10.3390/antiox8110509] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 10/20/2019] [Accepted: 10/23/2019] [Indexed: 12/24/2022] Open
Abstract
In the secondary injury phase after traumatic spinal cord injury (TSCI), oxidative stress and neuroinflammatory responses at the site of injury constitute crucial factors controlling damage extent and may serve as potential therapeutic targets. We determined Magnesium (Mg) serum concentration dynamics in context with the potential of neurological remission in patients with TSCI as Mg is suspected to limit the production of reactive oxygen species and reduce lipid peroxidation. A total of 29 patients with acute TSCI were enrolled, and blood samples were drawn over 3 months at 11 time-points and Mg quantification was performed. Patients were divided into those with (G1, n = 18) or without neurological remission (G0, n = 11). Results show a slight drop in Mg level during the first 4 h after injury, then remained almost unchanged in G1, but increased continuously during the first 7 days after injury in G0. At day 7 Mg concentrations in G1 and G0 were significantly different (p = 0.039, G0 > G1). Significant differences were detected between patients in G1 that presented an AIS (ASIA Impairment Scale) conversion of 1 level versus those with more than 1 level (p = 0.014, G1 AIS imp. = +1 > G1 AI imp. > +1). Low and decreasing levels of Mg within the first 7 days are indicative of a high probability of neurological remission, whereas increasing levels are associated with poor neurological outcome.
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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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Kijima K, Kubota K, Hara M, Kobayakawa K, Yokota K, Saito T, Yoshizaki S, Maeda T, Konno D, Matsumoto Y, Nakashima Y, Okada S. The acute phase serum zinc concentration is a reliable biomarker for predicting the functional outcome after spinal cord injury. EBioMedicine 2019; 41:659-669. [PMID: 30902739 PMCID: PMC6444130 DOI: 10.1016/j.ebiom.2019.03.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/28/2019] [Accepted: 03/01/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Spinal cord injury (SCI) is a devastating disorder for which the accurate prediction of the functional prognosis is urgently needed. Due to the lack of reliable prediction methods, the acute evaluation of SCI severity and therapeutic intervention efficacy is extremely difficult, presenting major obstacles to the development of acute SCI treatment. We herein report a novel method for accurately predicting the functional prognosis using the acute-phase serum zinc concentration after SCI. METHODS We produced experimental animal SCI models with different prognoses and examined the relationship among the SCI severity, functional outcome, and acute-phase serum zinc concentration. We also examined whether we could predict the functional prognosis by evaluating the serum zinc concentration within 72 h after SCI in a human prospective study. FINDINGS In a mouse model, the acute serum zinc concentrations decreased in proportion to SCI severity and the serum zinc concentrations at 12 h after SCI accurately predicted the functional prognosis. We clarified the mechanism underlying this serum zinc proportional decrease, showing that activated monocytes took up zinc from blood-serum and then infiltrated the lesion area in a severity-dependent manner. A non-linear regression analysis of 38 SCI patients showed that the serum zinc concentrations in the acute-phase accurately predicted the long-term functional outcome (R2 = 0·84) more accurately than any other previously reported acute-phase biomarkers. INTERPRETATION The acute-phase serum zinc concentration could be a useful biomarker for predicting the functional prognosis. This simple method will allow for more objective clinical trials and the development of patient-tailored treatment for SCI.
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Affiliation(s)
- Ken Kijima
- Department of Pathophysiology, Medical Institute of Bioregulation, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kensuke Kubota
- Department of Orthopaedic Surgery, Spinal Injuries Center, Iizuka, Japan
| | - Masamitsu Hara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazu Kobayakawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuya Yokota
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeyuki Saito
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shingo Yoshizaki
- Department of Pathophysiology, Medical Institute of Bioregulation, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeshi Maeda
- Department of Orthopaedic Surgery, Spinal Injuries Center, Iizuka, Japan
| | - Daijiro Konno
- Department of Pathophysiology, Medical Institute of Bioregulation, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiro Matsumoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Seiji Okada
- Department of Pathophysiology, Medical Institute of Bioregulation, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Yousefifard M, Sarveazad A, Babahajian A, Baikpour M, Shokraneh F, Vaccaro AR, Harrop JS, Fehlings MG, Hosseini M, Rahimi‐Movaghar V. Potential diagnostic and prognostic value of serum and cerebrospinal fluid biomarkers in traumatic spinal cord injury: A systematic review. J Neurochem 2019; 149:317-330. [DOI: 10.1111/jnc.14637] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/03/2018] [Accepted: 11/20/2018] [Indexed: 01/02/2023]
Affiliation(s)
- Mahmoud Yousefifard
- Physiology Research Center Faculty of Medicine Iran University of Medical Sciences Tehran Iran
| | - Arash Sarveazad
- Colorectal Research Center Iran University of Medical Sciences Tehran Iran
| | - Asrin Babahajian
- Liver and Digestive Research Center Kurdistan University of Medical Sciences Sanandaj Iran
| | - Masoud Baikpour
- Department of Medicine Tehran University of Medical Sciences Tehran Iran
| | - Farhad Shokraneh
- Cochrane Schizophrenia Group Institute of Mental Health University of Nottingham Nottingham UK
| | - Alexander R. Vaccaro
- Department of Orthopedics and Neurosurgery Rothman Institute Thomas Jefferson University Philadelphia Pennsylvania USA
| | - James S. Harrop
- Department of Neurosurgery Thomas Jefferson University Philadelphia Pennsylvania USA
| | - Michael G. Fehlings
- Division of Genetics and Development Krembil Research Institute University Health Network Toronto Ontario Canada
- Division of Neurosurgery, Toronto Western Hospital University Health Network Toronto Ontario Canada
- Department of Surgery and Spine Program University of Toronto Toronto Ontario Canada
| | - Mostafa Hosseini
- Department of Epidemiology and Biostatistics School of Public Health Tehran University of Medical Sciences Tehran Iran
| | - Vafa Rahimi‐Movaghar
- Sina Trauma and Surgery Research Center Tehran University of Medical Sciences Tehran Iran
- Brain and Spinal Injuries Research Center (BASIR) Neuroscience Institute Imam Khomeini Hospital Tehran University of Medical Sciences Tehran Iran
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O’Dell DR, Weber KA, Berliner JC, Elliott JM, Connor JR, Cummins DP, Heller KA, Hubert JS, Kates MJ, Mendoza KR, Smith AC. Midsagittal tissue bridges are associated with walking ability in incomplete spinal cord injury: A magnetic resonance imaging case series. J Spinal Cord Med 2018; 43:268-271. [PMID: 30346248 PMCID: PMC7054908 DOI: 10.1080/10790268.2018.1527079] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Context: Following spinal cord injury (SCI), early prediction of future walking ability is difficult, due to factors such as spinal shock, sedation, impending surgery, and secondary long bone fracture. Accurate, objective biomarkers used in the acute stage of SCI would inform individualized patient management and enhance both patient/family expectations and treatment outcomes. Using magnetic resonance imaging (MRI) and specifically a midsagittal T2-weighted image, the amount of tissue bridging (measured as spared spinal cord tissue) shows potential to serve as such a biomarker. Ten participants with incomplete SCI received MRI of the spinal cord. Using the midsagittal T2-weighted image, anterior and posterior tissue bridges were calculated as the distance from cerebrospinal fluid to the damage. Then, the midsagittal tissue bridge ratio was calculated as the sum of anterior and posterior tissue bridges divided by the spinal cord diameter. Each participant also performed a 6-minute walk test, where the total distance walked was measured within six minutes.Findings: The midsagittal tissue bridge ratio measure demonstrated a high level of inter-rater reliability (ICC = 0.90). Midsagittal tissue bridge ratios were significantly related to distance walked in six minutes (R = 0.68, P = 0.03).Conclusion/clinical relevance: We uniquely demonstrated that midsagittal tissue bridge ratios were correlated walking ability. These preliminary findings suggest potential for this measure to be considered a prognostic biomarker of residual walking ability following SCI.
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Affiliation(s)
- Denise R. O’Dell
- School of Physical Therapy, Regis University, Denver, Colorado, USA,Craig Hospital, Englewood, Colorado, USA
| | - Kenneth A. Weber
- Department of Anesthesia, Perioperative and Pain Medicine, Stanford University, Palo Alto, California, USA
| | | | - James M. Elliott
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia,Department of Physical Therapy and Human Movement Sciences, Northwestern University Evanston, Illinois, USA,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Jordan R. Connor
- School of Physical Therapy, Regis University, Denver, Colorado, USA
| | - David P. Cummins
- School of Physical Therapy, Regis University, Denver, Colorado, USA
| | | | - Joshua S. Hubert
- School of Physical Therapy, Regis University, Denver, Colorado, USA
| | - Megan J. Kates
- School of Physical Therapy, Regis University, Denver, Colorado, USA
| | | | - Andrew C. Smith
- School of Physical Therapy, Regis University, Denver, Colorado, USA,Correspondence to: Andrew C. Smith, Regis University School of Physical Therapy, 3333 Regis Boulevard, Peter Claver Hall, Suite 423D, Denver, CO 80221, USA; Ph: +1 (303) 458 4985.
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Quinzaños-Fresnedo J, Fratini-Escobar PC, Almaguer-Benavides KM, Aguirre-Güemez AV, Barrera-Ortíz A, Pérez-Zavala R, Villa-Romero AR. Prognostic validity of a clinical trunk control test for independence and walking in individuals with spinal cord injury. J Spinal Cord Med 2018; 43:331-338. [PMID: 30207875 PMCID: PMC7241519 DOI: 10.1080/10790268.2018.1518124] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Objective: The objective of the present work was to determine the prognostic validity of the trunk control test for walking and independence in individuals with SCI.Design: A cohort, prospective study was carried out in all individuals with sub-acute SCI.Setting: All inpatients at the Mexico City based National Rehabilitation Institute (INR).Participants: Ninety individuals with a clinical diagnosis of sub-acute SCI, American Spinal Injury Association Impairment Scale (AIS) A-D, and that have not participated in a rehabilitation program were included. Thirty-five individuals had good initial trunk control and the remaining 55 had poor trunk control. All individuals participated in a standard rehabilitation program subsequently.Interventions: N/AOutcome Measures: The trunk control test was performed at baseline. At 1, 3, 6, 9 and 12 months after the first evaluation, walking and independence were assessed.Results: Survival Analysis revealed that 62.5% and 100% individuals with good trunk control at baseline assessment were respectively walking and independent in ADL at 12 months and 14% and 48% individuals with poor trunk control were walking and independent in ADL. Cox regression analysis revealed that individuals with good trunk control were 4.6 times more likely to walk independently at 12 months and 2.9 times more likely to be independent in activities of daily living.Conclusion: The present study revealed that the trunk control test is useful for providing a prognosis of independence and walking at 1 year in individuals with SCI, independently of the neurologic level and the severity of the injury.
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Affiliation(s)
- Jimena Quinzaños-Fresnedo
- División de Rehabilitación Neurológica, Instituto Nacional de Rehabilitación, Ciudad de México, México,Correspondence to: Jimena Quinzaños-Fresnedo, División de Rehabilitación Neurologica, Instituto Nacional de RehabilitaciónAvenida México- Xochimilco No. 289, Col. Arenal de Guadalupe, Delegación Tlalpan, CP, Mexico City 14389, Mexico.
| | | | | | | | - Aída Barrera-Ortíz
- División de Rehabilitación Neurológica, Instituto Nacional de Rehabilitación, Ciudad de México, México
| | - Ramiro Pérez-Zavala
- División de Rehabilitación Neurológica, Instituto Nacional de Rehabilitación, Ciudad de México, México
| | - Antonio Rafael Villa-Romero
- División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
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Richard-Denis A, Feldman DE, Thompson C, Mac-Thiong JM. The impact of acute management on the occurrence of medical complications during the specialized spinal cord injury acute hospitalization following motor-complete cervical spinal cord injury. J Spinal Cord Med 2018; 41:388-396. [PMID: 28724333 PMCID: PMC6055977 DOI: 10.1080/10790268.2017.1350331] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
CONTEXT/OBJECTIVE Determine the impact of early admission and complete perioperative management in a specialized spinal cord injury (SCI) trauma center (SCI-center) on the occurrence of medical complications following tetraplegia. DESIGN A retrospective comparative cohort study of prospectively collected data involving 116 individuals was conducted. Group 1 (N=87) was early managed in a SCI-center promptly after the trauma, whereas Group 2 (N=29) was surgically and preoperatively managed in a non-specialized (NS) center before being transferred to the SCI-center. Bivariate comparisons and multivariate logistic regression analyses were used to assess the relationship between the type of acute care facility and the occurrence of medical complications. Length of stay (LOS) in acute care was also compared. SETTING Single Level-1 trauma center. PARTICIPANTS Individuals with acute traumatic motor-complete cervical SCI. INTERVENTIONS Not applicable Outcome measures: The occurrence of complications during the SCI-center stay. RESULTS There was a similar rate of complications between the two groups. However, the LOS was greater in Group 2 (p=0.04). High cervical injuries (C1-C4) showed an important tendency to increase the likelihood of developing a complication, while high cervical injuries and increased trauma severity increased the odds of developing respiratory complications. CONCLUSION Although complication rates were similar in non-specialized and specialized centers, peri-operative management in a non-specialized center required a longer length of stay. Prompt transfer to a SCI-center may optimize the care trajectory by favoring earlier transfer to rehabilitation.
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Affiliation(s)
- Andréane Richard-Denis
- Hôpital du Sacré-Coeur, Montréal, Canada,Faculty of Medicine, University of Montreal, Montreal, Canada,Correspondence to: Andréane Richard-Denis, MD, Department of Medicine, Hôpital du Sacré-Coeur de Montréal, 5400 Boul. Gouin Ouest, Montréal, Quebec, Canada, H4J 1C5.
| | | | | | - Jean-Marc Mac-Thiong
- Hôpital du Sacré-Coeur, Montréal, Canada,Faculty of Medicine, University of Montreal, Montreal, Canada,Hôpital Sainte-Justine, Montreal, Canada
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Richard-Denis A, Beauséjour M, Thompson C, Nguyen BH, Mac-Thiong JM. Early Predictors of Global Functional Outcome after Traumatic Spinal Cord Injury: A Systematic Review. J Neurotrauma 2018; 35:1705-1725. [PMID: 29455634 DOI: 10.1089/neu.2017.5403] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Accurately predicting functional recovery is an asset for all clinicians and decision makers involved in the care of patients with acute traumatic spinal cord injury (TSCI). Unfortunately, there is a lack of information on the relative importance of significant predictors of global functional outcome. There is also a need for identifying functional predictors that can be timely optimized by the medical and rehabilitation teams throughout the hospitalizations phases. The main objective of this work was to systematically review and rate early factors that are consistently and independently associated with global functional outcome in individuals with TSCI. A literature search using MEDLINE, EMBASE, and Cochrane databases from January 1, 1970 to April 1, 2017 was performed. Two authors independently reviewed the titles and abstracts yielded by this literature search and subsequently selected studies to be included based on predetermined eligibility criteria. Disagreements were resolved by a consensus-based discussion, and if not, by an external reviewer. Data were extracted by three independent reviewers using a standardized table. The quality of evidence of the individual studies was assessed based on the Oxford Center for Evidence-Based Medicine modified by Wright and colleagues (2000) as well as the National Institutes of Health (2014). Fifteen articles identifying early clinical predictors of functional outcome using multiple regression analyses were included in this systematic review. Based on the compiled data, this review proposes a rating of early factors associated to global functional outcome according to their importance and their potential to be modified by the medical/rehabilitation team throughout the early phases of hospitalization. It also proposes a new conceptual framework that illustrates the impact of specific categories of factors and their interaction with each other. Ultimately, this review aims to guide clinicians and researchers in improving the continuum of care throughout early phases post-SCI.
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Affiliation(s)
- Andréane Richard-Denis
- 1 Hôpital du Sacré-Cœur de Montréal , Montréal, Quebec, Canada .,2 Department of Medicine, Faculty of Medicine, University of Montréal , Montréal, Quebec, Canada
| | - Marie Beauséjour
- 4 Sainte-Justine University Hospital Research Center , Montréal, Quebec, Canada
| | | | - Bich-Han Nguyen
- 2 Department of Medicine, Faculty of Medicine, University of Montréal , Montréal, Quebec, Canada .,5 Institut de réadaptation Gingras-Lindsay de Montréal , Montréal, Quebec, Canada
| | - Jean-Marc Mac-Thiong
- 1 Hôpital du Sacré-Cœur de Montréal , Montréal, Quebec, Canada .,3 Department of Surgery, Faculty of Medicine, University of Montréal , Montréal, Quebec, Canada .,4 Sainte-Justine University Hospital Research Center , Montréal, Quebec, Canada
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