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Kisala PA, Boulton AJ, Slavin MD, Cohen ML, Keeney T, Ni P, Tate D, Heinemann AW, Charlifue S, Fyffe DC, Felix ER, Jette AM, Tulsky DS. Spinal Cord Injury-Functional Index/Capacity: Responsiveness to Change Over Time. Arch Phys Med Rehabil 2022; 103:199-206. [PMID: 34717921 PMCID: PMC8810572 DOI: 10.1016/j.apmr.2021.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 09/21/2021] [Accepted: 10/01/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To establish responsiveness of 3 Spinal Cord Injury-Functional Index/Capacity (SCI-FI/C) item banks in the first year after spinal cord injury (SCI). DESIGN Longitudinal patient-reported outcomes assessment replicated through secondary analysis of an independent data set. SETTING A total of 8 SCI Model Systems rehabilitation hospitals in the United States. PARTICIPANTS Study 1 participants included 184 adults with recent (≤4 months) traumatic SCI and 221 community-dwelling adults (>1 year post injury) (N=405). Study 2 participants were 418 individuals with recent SCI (≤4 months) (N=418). INTERVENTIONS In study 1, SCI-FI/C computer adaptive tests were presented in a standardized interview format either in person or by phone call at baseline and 6-month follow-up. Responsiveness was examined by comparing 6-month changes in SCI-FI scores within and across samples (recently injured vs community-dwelling) because only the recent injury sample was expected to exhibit change over time. Effect sizes were also computed. In study 2, the study 1 results were cross-validated in a second sample with recent SCI 1 year after baseline measurement. Study 2 also compared the SCI-FI/C measures' responsiveness to that of the Self-reported Functional Measure (SRFM) and stratified results by injury diagnosis and completeness. MAIN OUTCOME MEASURES The SCI-FI Basic Mobility/C, Self-care/C and Fine Motor/C item banks (study 1 and study 2); Self-reported Functional Measure SRFM (study 2 only). RESULTS In study 1, changes in SCI-FI/C scores between baseline and 6-month follow-up were statistically significant (P<.01) for recently injured individuals. SCI-FI Basic Mobility/C, Self-care/C, and Fine Motor/C item banks demonstrated small to medium effect sizes in the recently injured sample. In the community-dwelling sample, all SCI-FI/C effects were negligible (ie, effect size<0.08). Study 2 results were similar to study 1. As expected, SCI-FI Basic Mobility/C and Self-care/C were responsive to change for all individuals in study 2, whereas the SCI-FI Fine Motor/C was responsive only for individuals with tetraplegia and incomplete paraplegia. The SRFM demonstrated a medium effect size for responsiveness (effect size=0.65). CONCLUSIONS The SCI-FI Basic Mobility/C and Self-care/C banks demonstrate adequate sensitivity to change at 6 months and 1 year for all individuals with SCI, while the SCI-FI/C Fine Motor item bank is sensitive to change in individuals with tetraplegia or incomplete paraplegia. All SCI-FI/C banks demonstrate stability in a sample not expected to change. Results provide support for the use of these measures for research or clinical use.
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Affiliation(s)
- Pamela A. Kisala
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE
| | - Aaron J. Boulton
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE
| | - Mary D. Slavin
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
| | - Matthew L. Cohen
- Dept. of Communication Sciences and Disorders and Center for Health Assessment Research and Translation, University of Delaware, Newark, DE
| | - Tamra Keeney
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital,Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital
| | - Pengsheng Ni
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
| | - Denise Tate
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Allen W. Heinemann
- Shirley Ryan AbilityLab and Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Denise C. Fyffe
- Kessler Foundation, West Orange, NJ and New Jersey Medical School, Newark, NJ
| | - Elizabeth R. Felix
- Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, FL
| | - Alan M. Jette
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital
| | - David S. Tulsky
- Center for Health Assessment Research and Translation and Departments of Physical Therapy and Psychological and Brain Sciences, University of Delaware, Newark, DE
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Duzgun Celik H, Cagliyan Turk A, Sahin F, Yilmaz F, Kuran B. Comparison of disability and quality of life between patients with pediatric and adult onset paraplegia. J Spinal Cord Med 2018; 41:645-652. [PMID: 28102106 PMCID: PMC6217506 DOI: 10.1080/10790268.2016.1275447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To investigate the factors that affect disability and quality of life in patients with spinal cord injuries (SCIs) and to compare the degree of disability and quality of life in patients with SCI according to over and under 18 years of age when their injury occurred. DESIGN Cohort study. SETTING Two academic hospitals in Istanbul, Turkey. PARTICIPANTS Forty patients with SCI were included in this study. Group 1 included 20 patients with SCI who were younger than 18 years of age when their injury occurred, Group 2 included 20 patients who were older than 18 years of age when their injury occurred. OUTCOME MEASURES Patients' demographics, duration of SCI and degree of disability were assessed using the Craig Handicap Assessment and Reporting Technique (CHART). Quality of life was assessed using the World Health Organization Quality of Life Scale Short Form (WHOQOL-Bref). Depression was assessed using the Beck Depression Inventory (BDI). RESULTS Although there was no significant difference between the BDI scores and CHART scores of the two groups, environment domain scores in the WHOQOL-Bref were significantly higher in Group 2 than in Group 1 (P<0.05). No significant correlation was found between age of SCI onset, disease duration, ASIA scores, depression scores, total CHART scores for all patients. CONCLUSION Adaptation to environment was significantly better in those who suffered SCI during adulthood than in pediatric patients with SCI. Disability level was not associated with age of disease onset, disease duration, neurological status, depression level.
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Affiliation(s)
- Hanife Duzgun Celik
- Private Konak Medical Center, Department of Physical Medicine and Rehabilitation, Sakarya, Turkey
| | - Ayla Cagliyan Turk
- Hitit University Training and Research Hospital, Department of Physical Medicine and Rehabilitation, Corum, Turkey,Correspondence to: Ayla Cagliyan Turk, MD, Department of Physical Medicine and Rehabilitation, Hitit University, Training and Research Hospital, 19200, Corum, Turkey.
| | - Fusun Sahin
- Pamukkale University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Denizli, Turkey
| | - Figen Yilmaz
- Hamidiye Sisli Etfal Training and Research Hospital, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey
| | - Banu Kuran
- Hamidiye Sisli Etfal Training and Research Hospital, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey
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Abstract
BACKGROUND A tertiary spinal cord injury (SCI) center was established in the northern region of Hong Kong, China and a multidisciplinary SCI rehabilitation program was developed to reintegrate patients into the community. OBJECTIVE To investigate functional outcomes for Chinese people with SCI across a 1-year period. DESIGN Longitudinal prospective design. METHODS Thirty community-dwelling participants with traumatic SCI were recruited. Functional status was measured using functional independence measure (FIM) on admission, upon discharge, 1-month, 3-month, 6-month, and 1-year post-discharge. Information on use of assistive devices and life role were also obtained. RESULTS Twenty-three (76.67%) participants were men. Seventeen participants (10 with tetraplegia and 7 with paraplegia) were classified ASIA A, B, or C; 13 (7 with tetraplegia and 6 with paraplegia) were classified as ASIA D. Significant differences in FIM motor scores were only found between the tetraplegia group and three other diagnostic groups using Bonferroni post-hoc tests of repeated measure ANOVA (analysis of variance) (P < 0.05). Longitudinally, contrast tests of repeated measure ANOVA showed significant differences during the hospitalization period for all diagnostic groups. People in the ASIA D group showed significant functional improvement even after 1-year post-discharge (P < 0.05). At 1-year post-discharge, only two participants were engaged in either remunerative employment or academic pursuit. CONCLUSION Despite functional status improvement, few people with traumatic SCI were re-engaged in productive life role 1 year after discharge. Studies with longer follow-up would be beneficial.
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Affiliation(s)
- Sam Chi Chung Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China.
| | - Alice Po Shan Chan
- Occupational Therapy Department, Tai Po Hospital, Tai Po, NT, Hong Kong, China
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Abstract
Study Design Prospective cohort study Objective This study was designed to neurophysiologically characterize motor control recovery after spinal cord injury (SCI). Setting University of Louisville, Louisville, Kentucky, USA. Material Eleven acute SCI admissions and five non-injured subjects were recruited for this study. Methods The American Spinal Injury Association Impairment Scale (AIS) was used to categorize injury level and severity at onset. Multi-muscle surface EMG (sEMG) recording protocol of reflex and volitional motor tasks was initially performed between the day of injury and 11 days post onset (6.4 ± 3.6, mean ± SD days). Follow-up recordings were performed for up to 17 months after injury. Initial AIS distribution was: 4 AIS-A; 2 AIS-C; 5 AIS-D. Multi-muscle activation patterns were quantified from the sEMG amplitudes of selected muscles using a vector-based calculation that produces values for Magnitude and Similarity of SCI test-subject patterns to those produced by non-injured subjects. Results In SCI subjects, overall sEMG amplitudes were lower after SCI. Prime mover muscle voluntary recruitment was slower and multi-muscle patterns were disrupted by SCI. Recovery occurred in 9 of the 11 showing an increase in sEMG amplitudes, more rapid prime mover muscle recruitment rates and the progressive normalization of the multi-muscle activation patterns. The rate of increase was highly individualized, differing over time by limb and proximal or distal joint within each subject and across the SCI group. Conclusions Recovery of voluntary motor function can be quantitatively tracked using neurophysiological methods in the domains of time and multi-muscle motor unit activation. Sponsorship NIH NINDS funded project #NS049954-01
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Abstract
OBJETIVOS: Investigar características de indivíduos com lesão de medula espinhal atendidos em hospitais públicos de Ribeirão Preto - São Paulo, e avaliar a independência funcional segundo nível de lesão, tempo pós-lesão e reabilitação. MÉTODOS: Estudo de observação transversal realizado de janeiro de 2003 a julho 2006 abrangendo 22 pacientes atendidos nesses hospitais, com avaliação da capacidade funcional pela escala Medida de Independência Funcional (MIF). RESULTADOS: Dos 22 pacientes que sobreviveram após saída hospitalar, 91% eram homens, com idade de 30 a 39 anos (36,4%). A etiologia principal da referida lesão foi acidente de trânsito (50%) e 11 pacientes (50%), tiveram lesão cervical, 10 (45,5%) lesão torácica e um lesão lombar. Nos indivíduos com lesão cervical os escores na MIF total e motora foram menores implicando em menor capacidade funcional. Observou-se aumento dos escores da MIF com o aumento do tempo pós-lesão, independente da participação em programa de reabilitação. CONCLUSÕES: Os resultados apontam aspectos essenciais para a proposição de programa de reabilitação para esta população no contexto estudado.
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Spiess MR, Müller RM, Rupp R, Schuld C, van Hedel HJA. Conversion in ASIA impairment scale during the first year after traumatic spinal cord injury. J Neurotrauma 2010; 26:2027-36. [PMID: 19456213 DOI: 10.1089/neu.2008.0760] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The neurological severity of a spinal cord injury (SCI) is commonly classified according to the American Spinal Injury Association (ASIA) Impairment Scale (AIS). The aim of this study was to assess the course of the AIS following SCI, and to discern the nature of any changes in the classification that occur. Assessments were performed in a European cohort of SCI patients within 2 weeks and at 1, 3, 6, and 12 months after the initial injury. Overall, about 70% of the patients initially diagnosed as AIS A did not convert, as did 90% of the AIS D patients. When only evaluating patients with complete datasets, 68% did not convert, while the AIS category improved in 30% of patients and deteriorated in 2%. A change in the last sacral segments (40%), motor improvement (31%), sensory improvement (19%), and a change in the neurological level of the SCI (10%) contributed to or accompanied the AIS conversion. When the AIS remained unchanged between successive assessment points, there was no change in the number of muscles graded three or more (NMG3(+)) in 73% of the transitions. An improvement in AIS was associated with a gain in NMG3(+) in 49% of the transitions, while an aggravation in AIS was accompanied by a loss in NMG3(+) in 10% of the transitions. These results, documenting a substantial amount of spontaneous AIS conversions, should be taken into consideration when designing clinical trials to assess the effects of potential new treatments for SCI.
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Affiliation(s)
- Martina R Spiess
- SCI Research, Spinal Cord Injury Center, University of Zurich, Balgrist University Hospital, Zurich, Switzerland
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Spiess MR, Mueller RM, Rupp R, Schuld C, van Hedel HJ. Conversion in ASIA Impairment Scale during the first year after traumatic spinal cord injury. J Neurotrauma 2009. [DOI: 10.1089/neu.2008-0760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Evolution of tibial SSEP after traumatic spinal cord injury: Baseline for clinical trials. Clin Neurophysiol 2008; 119:1051-61. [DOI: 10.1016/j.clinph.2008.01.021] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Revised: 01/22/2008] [Accepted: 01/31/2008] [Indexed: 12/20/2022]
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Zimmer MB, Nantwi K, Goshgarian HG. Effect of spinal cord injury on the respiratory system: basic research and current clinical treatment options. J Spinal Cord Med 2007; 203:98-108. [PMID: 17853653 DOI: 10.1016/j.resp.2014.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/11/2014] [Accepted: 08/12/2014] [Indexed: 02/09/2023] Open
Abstract
Spinal cord injury (SCI) often leads to an impairment of the respiratory system. The more rostral the level of injury, the more likely the injury will affect ventilation. In fact, respiratory insufficiency is the number one cause of mortality and morbidity after SCI. This review highlights the progress that has been made in basic and clinical research, while noting the gaps in our knowledge. Basic research has focused on a hemisection injury model to examine methods aimed at improving respiratory function after SCI, but contusion injury models have also been used. Increasing synaptic plasticity, strengthening spared axonal pathways, and the disinhibition of phrenic motor neurons all result in the activation of a latent respiratory motor pathway that restores function to a previously paralyzed hemidiaphragm in animal models. Human clinical studies have revealed that respiratory function is negatively impacted by SCI. Respiratory muscle training regimens may improve inspiratory function after SCI, but more thorough and carefully designed studies are needed to adequately address this issue. Phrenic nerve and diaphragm pacing are options available to wean patients from standard mechanical ventilation. The techniques aimed at improving respiratory function in humans with SCI have both pros and cons, but having more options available to the clinician allows for more individualized treatment, resulting in better patient care. Despite significant progress in both basic and clinical research, there is still a significant gap in our understanding of the effect of SCI on the respiratory system.
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Affiliation(s)
- M Beth Zimmer
- Department of Anatomy and Cell Biology, Wayne State University, Detroit, Michigan 48201, USA.
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Edwards LC, Layne CS. Effect of Dynamic Weight Bearing on Neuromuscular Activation After Spinal Cord Injury. Am J Phys Med Rehabil 2007; 86:499-506. [PMID: 17515690 DOI: 10.1097/phm.0b013e31805b764b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether individuals who have a spinal cord injury have neuromuscular and physiologic responses to a personalized exercise program during dynamic weight bearing (DWB). DESIGN Four subjects with spinal cord injuries (T6, T5-6, C2-5, and C5) completed a 12-wk exercise program that included DWB. Surface electromyography (EMG) was recorded from the right gastrocnemius, biceps femoris, rectus femoris, rectus abdominus, and external oblique. Heart rate (HR) and blood pressure (BP) were recorded throughout training. Descriptive statistics were used to analyze the data. RESULTS The results of this study indicate that the subjects actively responded to exercise during DWB, as measured by EMG, HR, and BP. CONCLUSIONS The results suggest that exercise during DWB can induce physiologic and neuromuscular responses in individuals who have a spinal cord injury, and that exercise during DWB may serve as a preparatory program for more advanced rehabilitation.
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Affiliation(s)
- Lindsay C Edwards
- Laboratory of Integrated Physiology, 3855 Holman Street, Houston, TX 77204, USA
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Zimmer MB, Nantwi K, Goshgarian HG. Effect of spinal cord injury on the respiratory system: basic research and current clinical treatment options. J Spinal Cord Med 2007; 30:319-30. [PMID: 17853653 PMCID: PMC2031930 DOI: 10.1080/10790268.2007.11753947] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Accepted: 02/05/2007] [Indexed: 10/21/2022] Open
Abstract
Spinal cord injury (SCI) often leads to an impairment of the respiratory system. The more rostral the level of injury, the more likely the injury will affect ventilation. In fact, respiratory insufficiency is the number one cause of mortality and morbidity after SCI. This review highlights the progress that has been made in basic and clinical research, while noting the gaps in our knowledge. Basic research has focused on a hemisection injury model to examine methods aimed at improving respiratory function after SCI, but contusion injury models have also been used. Increasing synaptic plasticity, strengthening spared axonal pathways, and the disinhibition of phrenic motor neurons all result in the activation of a latent respiratory motor pathway that restores function to a previously paralyzed hemidiaphragm in animal models. Human clinical studies have revealed that respiratory function is negatively impacted by SCI. Respiratory muscle training regimens may improve inspiratory function after SCI, but more thorough and carefully designed studies are needed to adequately address this issue. Phrenic nerve and diaphragm pacing are options available to wean patients from standard mechanical ventilation. The techniques aimed at improving respiratory function in humans with SCI have both pros and cons, but having more options available to the clinician allows for more individualized treatment, resulting in better patient care. Despite significant progress in both basic and clinical research, there is still a significant gap in our understanding of the effect of SCI on the respiratory system.
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Affiliation(s)
- M Beth Zimmer
- Department of Anatomy and Cell Biology, Wayne State University, Detroit, Michigan 48201, USA.
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