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Vora I, Kline DK, McCauley CA, Link A, Asiello JD, Gaudino SG, Reilly WJ, Keilty MS, Banks RE, Kimberley TJ. Psychometric properties of light touch-pressure somatosensory measures in adults with neurological disorders: A systematic review. Clin Rehabil 2023:2692155231152417. [PMID: 36794517 DOI: 10.1177/02692155231152417] [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: 02/17/2023]
Abstract
OBJECTIVES To critically appraise the psychometric properties of light touch-pressure somatosensory assessments to provide guidance for tool selection for research or clinical purposes. DATA SOURCES MEDLINE, CINAHL, and PsycInfo were searched for research indexed from January 1990-November 2022. English language and human subject filters were applied. "Somatosensation", "psychometric property", and "nervous system-based health condition" search terms were combined. Grey literature and manual searches were conducted to ensure thoroughness. REVIEW METHODS The reliability, construct validity, and/or measurement error of light touch-pressure assessments was reviewed in adult populations with neurological disorders. Reviewers individually extracted and managed data including patient demographics, assessment characteristics, statistical methods, and psychometric properties. Methodological quality of results was evaluated using an adapted version of the COnsensus-based Standards for the selection of health Measurement INstruments checklist. RESULTS Thirty-three of 1938 articles were included for review. Fifteen light touch-pressure assessments demonstrated good or excellent reliability. Further, five of those 15 assessments achieved adequate validity and one of the 15 assessments achieved adequate measurement error. Over 80% of the summarized study ratings were determined to be of low or very low quality. CONCLUSION We recommend using electrical perceptual tests, the Semmes-Weinstein Monofilaments, the Graded and Redefined Assessment of Strength, Sensibility, and Prehension, and the Moving Touch Pressure Test given that they demonstrated good to excellent results in three psychometric properties. No other assessment achieved adequate ratings in more than two psychometric properties. This review highlights a fundamental need to develop sensory assessments that are reliable, valid, and sensitive to change.
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Affiliation(s)
- Isha Vora
- Department of Rehabilitation Sciences, 15646MGH Institute of Health Professions, Boston, MA, USA
| | - Danielle K Kline
- Department of Rehabilitation Sciences, 15646MGH Institute of Health Professions, Boston, MA, USA
| | - Colleen A McCauley
- Department of Physical Medicine and Rehabilitation, 440489Spaulding Rehabilitation Hospital Cape Cod, Cape Cod, MA, USA
| | - Angela Link
- Department of Physical Medicine and Rehabilitation, 621778Spaulding Rehabilitation Hospital Boston, Boston, MA, USA
| | - Jessica D Asiello
- Department of Occupational Therapy, 2348Massachusetts General Hospital, Boston, MA, USA.,Department of Occupational Therapy, 15646MGH Institute of Health Professions, Boston, MA, USA
| | | | - William J Reilly
- Department of Physical Medicine and Rehabilitation, 621777Spaulding Rehabilitation Hospital Cambridge, Cambridge, MA, USA
| | - Matthew S Keilty
- Department of Physical Medicine and Rehabilitation, 440489Spaulding Rehabilitation Hospital Cape Cod, Cape Cod, MA, USA
| | - Russell E Banks
- Department of Physical Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | - Teresa J Kimberley
- Department of Rehabilitation Sciences, 15646MGH Institute of Health Professions, Boston, MA, USA.,Department of Physical Therapy, MGH Institute of Health Professions, Boston, MA, USA
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Albu S, Kumru H, Coll R, Vives J, Vallés M, Benito-Penalva J, Rodríguez L, Codinach M, Hernández J, Navarro X, Vidal J. Clinical effects of intrathecal administration of expanded Wharton jelly mesenchymal stromal cells in patients with chronic complete spinal cord injury: a randomized controlled study. Cytotherapy 2020; 23:146-156. [PMID: 32981857 DOI: 10.1016/j.jcyt.2020.08.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/01/2020] [Accepted: 08/20/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AIMS Spinal cord injury (SCI) represents a devastating condition leading to severe disability related to motor, sensory and autonomic dysfunction. Stem cell transplantation is considered a potential emerging therapy to stimulate neuroplastic and neuroregenerative processes after SCI. In this clinical trial, the authors investigated the safety and clinical recovery effects of intrathecal infusion of expanded Wharton jelly mesenchymal stromal cells (WJ-MSCs) in chronic complete SCI patients. METHODS The authors designed a randomized, double-blind, crossover, placebo-controlled, phase 1/2a clinical trial (NCT03003364). Participants were 10 patients (7 males, 3 females, age range, 25-47 years) with chronic complete SCI (American Spinal Injury Association A) at dorsal level (T3-11). Patients were randomly assigned to receive a single dose of intrathecal ex vivo-expanded WJ-MSCs (10 × 106 cells) from human umbilical cord or placebo and were then switched to the other arm at 6 months. Clinical evaluation (American Spinal Injury Association impairment scale motor and sensory score, spasticity, neuropathic pain, electrical perception and pain thresholds), lower limb motor evoked potentials (MEPs) and sensory evoked potentials (SEPs), Spinal Cord Independence Measure and World Health Organization Quality of Life Brief Version were assessed at baseline, 1 month, 3 months and 6 months after each intervention. Urodynamic studies and urinary-specific quality of life (Qualiveen questionnaire) as well as anorectal manometry, functional assessment of bowel dysfunction (Rome III diagnostic questionnaire) and severity of fecal incontinence (Wexner score) were conducted at baseline and at 6 months after each intervention. RESULTS Intrathecal transplantation of WJ-MSCs was considered safe, with no significant side effects. Following MSC infusion, the authors found significant improvement in pinprick sensation in the dermatomes below the level of injury compared with placebo. Other clinically relevant effects, such as an increase in bladder maximum capacity and compliance and a decrease in bladder neurogenic hyperactivity and external sphincter dyssynergy, were observed only at the individual level. No changes in motor function, spasticity, MEPs, SEPs, bowel function, quality of life or independence measures were observed. CONCLUSIONS Intrathecal transplantation of human umbilical cord-derived WJ-MSCs is a safe intervention. A single intrathecal infusion of WJ-MSCs in patients with chronic complete SCI induced sensory improvement in the segments adjacent to the injury site.
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Affiliation(s)
- Sergiu Albu
- Fundación Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Hospital de Neurorehabilitació, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Hatice Kumru
- Fundación Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Hospital de Neurorehabilitació, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain.
| | - Ruth Coll
- Research and Education, Banc de Sang i Teixits, Barcelona, Spain
| | - Joaquim Vives
- Cell Therapy Service, Banc de Sang i Teixits, Barcelona, Spain
| | - Margarita Vallés
- Fundación Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Hospital de Neurorehabilitació, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Jesús Benito-Penalva
- Fundación Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Hospital de Neurorehabilitació, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | | | | | - Joaquim Hernández
- Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Barcelona, Spain
| | - Xavier Navarro
- Fundación Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Hospital de Neurorehabilitació, Barcelona, Spain; Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Barcelona, Spain
| | - Joan Vidal
- Fundación Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Hospital de Neurorehabilitació, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
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Curt A, Hsieh J, Schubert M, Hupp M, Friedl S, Freund P, Huber E, Pfyffer D, Sutter R, Jutzeler C, Wüthrich RP, Min K, Casha S, Fehlings MG, Guzman R. The Damaged Spinal Cord Is a Suitable Target for Stem Cell Transplantation. Neurorehabil Neural Repair 2020; 34:758-768. [PMID: 32698674 DOI: 10.1177/1545968320935815] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background. Given individuals with spinal cord injury (SCI) approaching 2 million, viable options for regenerative repair are desperately needed. Human central nervous system stem cells (HuCNS-SC) are self-renewing, multipotent adult stem cells that engraft, migrate, and differentiate in appropriate regions in multiple animal models of injured brain and spinal cord. Preclinical improved SCI locomotor function provided rationale for the first-in-human SCI clinical trial of HuCNS-SC cells. Evidence of feasibility and long-term safety of cell transplantation into damaged human cord is needed to foster translational progression of cellular therapies. Methods. A first-ever, multisite phase I/IIa trial involving surgical transplantation of 20 million HuCNS-SC cells into the thoracic cord in 12 AIS A or B subjects (traumatic, T2-T11 motor-complete, sensory-incomplete), aged 19 to 53 years, demonstrated safety and preliminary efficacy. Six-year follow-up data were collected (sensory thresholds and neuroimaging augmenting clinical assessments). Findings. The study revealed short- and long-term surgical and medical safety (well-tolerated immunosuppression in population susceptible to infections). Preliminary efficacy measures identified 5/12 with reliable sensory improvements. Unfortunately, without thoracic muscles available for manual muscle examination, thoracic motor changes could not be measured. Lower limb motor scores did not change during the study. Cervical cord imaging revealed, no tumor formation or malformation of the lesion area, and secondary supralesional structural changes similar to SCI control subjects. Interpretation. Short- and long-term safety and feasibility support the consideration of cell transplantation for patients with complete and incomplete SCI. This report is an important step to prepare, foster, and maintain the therapeutic development of cell transplantation for human SCI.
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Affiliation(s)
- Armin Curt
- Balgrist University Hospital, Zurich, Switzerland
| | - Jane Hsieh
- Balgrist University Hospital, Zurich, Switzerland
| | | | - Markus Hupp
- Balgrist University Hospital, Zurich, Switzerland
| | | | | | | | | | - Reto Sutter
- Balgrist University Hospital, Zurich, Switzerland
| | | | | | - Kan Min
- Balgrist University Hospital, Zurich, Switzerland
| | - Steve Casha
- University of Calgary, Calgary, Alberta, Canada
| | - Michael G Fehlings
- Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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Application of electrophysiological measures in spinal cord injury clinical trials: a narrative review. Spinal Cord 2019; 57:909-923. [PMID: 31337870 DOI: 10.1038/s41393-019-0331-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 01/05/2023]
Abstract
STUDY DESIGN Narrative review. OBJECTIVES To discuss how electrophysiology may contribute to future clinical trials in spinal cord injury (SCI) in terms of: (1) improvement of SCI diagnosis, patient stratification and determination of exclusion criteria; (2) the assessment of adverse events; and (3) detection of therapeutic effects following an intervention. METHODS An international expert panel for electrophysiological measures in SCI searched and discussed the literature focused on the topic. RESULTS Electrophysiology represents a valid method to detect, track, and quantify readouts of nerve functions including signal conduction, e.g., evoked potentials testing long spinal tracts, and neural processing, e.g., reflex testing. Furthermore, electrophysiological measures can predict functional outcomes and thereby guide rehabilitation programs and therapeutic interventions for clinical studies. CONCLUSION Objective and quantitative measures of sensory, motor, and autonomic function based on electrophysiological techniques are promising tools to inform and improve future SCI trials. Complementing clinical outcome measures, electrophysiological recordings can improve the SCI diagnosis and patient stratification, as well as the detection of both beneficial and adverse events. Specifically composed electrophysiological measures can be used to characterize the topography and completeness of SCI and reveal neuronal integrity below the lesion, a prerequisite for the success of any interventional trial. Further validation of electrophysiological tools with regard to their validity, reliability, and sensitivity are needed in order to become routinely applied in clinical SCI trials.
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Cuatrecasas G, Kumru H, Coves MJ, Vidal J. GH deficiency in patients with spinal cord injury: efficacy/safety of GH replacement, a pilot study. Endocr Connect 2018; 7:1031-1039. [PMID: 30352393 PMCID: PMC6198193 DOI: 10.1530/ec-18-0296] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 08/13/2018] [Indexed: 12/14/2022]
Abstract
Objective Growth hormone (GH) was shown to stimulate proliferation, migration and survival of neural cells in animal models. GH deficiency (GHD) was reported following traumatic brain lesions; however, there are not available data in spinal cord injury (SCI) patients. The aim of the study was to evaluate (1) the frequency of GHD in chronic SCI population; (2) the efficacy/safety of GH replacement in patients with SCI and suboptimal GH secretion. Design and methods Nineteen consecutive patients with chronic thoracic complete SCI (AIS-A) were studied. Patients with low GH secretion were randomized in a double-blind, placebo-controlled study to receive either subcutaneous placebo injections or GH combined with physical therapy, for 6 months. Baseline cranial MRI, AIS motor and sensory scale, quality of life (spinal cord impact measurement) and modified Ashworth spasticity scale, quantitative sensory testing and neurophysiological exploration were assessed at baseline, 1, 3 and 6 months following treatment. Results Thirteen had GH deficiency. Seven received GH, five placebo and one dropped out. Both groups were similar according to clinical and demographical data at baseline, except for greater GH deficiency in the GH treatment group. At 6th month, patients treated with GH showed a significant improvement in SCIM-III score and in electrical perception threshold up to the 5th level below SCI, on both sides compared to baseline. Conclusions GHD seems to be frequent in traumatic SCI and GH replacement is safe without side effects. GH combined with physical therapy can improve quality of life of SCI patients and, strikingly, the sensory perception below lesion level.
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Affiliation(s)
- Guillem Cuatrecasas
- Endocrinology DepartmentHospital Quiron-Teknon, CPEN S.L., Barcelona, Spain
- Universitat Oberta Catalunya (UOC)Barcelona, Spain
- Correspondence should be addressed to G Cuatrecasas:
| | - Hatice Kumru
- Institut GuttmannInstitut Universitari de Neurorehabilitació Adscrit a la UAB, Barcelona, Spain
- Univ Autònoma de BarcelonaCerdanyola del Vallès, Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i PujolBarcelona, Spain
| | - M Josep Coves
- Endocrinology DepartmentHospital Quiron-Teknon, CPEN S.L., Barcelona, Spain
| | - Joan Vidal
- Institut GuttmannInstitut Universitari de Neurorehabilitació Adscrit a la UAB, Barcelona, Spain
- Univ Autònoma de BarcelonaCerdanyola del Vallès, Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i PujolBarcelona, Spain
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Krishna V, Andrews H, Varma A, Mintzer J, Kindy MS, Guest J. Spinal cord injury: how can we improve the classification and quantification of its severity and prognosis? J Neurotrauma 2014; 31:215-27. [PMID: 23895105 DOI: 10.1089/neu.2013.2982] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The preservation of functional neural tissue after spinal cord injury (SCI) is the basis for spontaneous neurological recovery. Some injured patients in the acute phase have more potential for recovery than others. This fact is problematic for the construction of clinical trials because enrollment of subjects with variable recovery potential makes it difficult to detect effects, requires large sample sizes, and risks Type II errors. In addition, the current methods to assess injury and recovery are non-quantitative and not sensitive. It is likely that therapeutic combinations will be necessary to cause substantially improved function after SCI, thus we need highly sensitive techniques to evaluate changes in motor, sensory, autonomic and other functions. We review several emerging neurophysiological techniques with high sensitivity. Quantitative methods to evaluate residual tissue sparing after severe acute SCI have not entered widespread clinical use. This reduces the ability to correlate structural preservation with clinical outcome following SCI resulting in enrollment of subjects with varying patterns of tissue preservation and injury into clinical trials. We propose that the inclusion of additional measures of injury severity, pattern, and individual genetic characteristics may enable stratification in clinical trials to make the testing of therapeutic interventions more effective and efficient. New imaging techniques to assess tract injury and demyelination and methods to quantify tissue injury, inflammatory markers, and neuroglial biochemical changes may improve the evaluation of injury severity, and the correlation with neurological outcome, and measure the effects of treatment more robustly than is currently possible. The ability to test such a multimodality approach will require a high degree of collaboration between clinical and research centers and government research support. When the most informative of these assessments is determined, it may be possible to identify patients with substantial recovery potential, improve selection criteria and conduct more efficient clinical trials.
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Affiliation(s)
- Vibhor Krishna
- 1 Department of Neurosciences, Medical University of South Carolina , Charleston, South Carolina
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Velstra IM, Bolliger M, Baumberger M, Rietman JS, Curt A. Epicritic Sensation in Cervical Spinal Cord Injury: Diagnostic Gains Beyond Testing Light Touch. J Neurotrauma 2013; 30:1342-8. [DOI: 10.1089/neu.2012.2828] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
| | - Marc Bolliger
- Spinal Cord Injury Centre, Balgrist University Hospital, Zurich, Switzerland
- European Multicenter Study about Human Spinal Cord Injury (EM SCI), Zurich, Switzerland
| | - Michael Baumberger
- Department of Acute and Rehabilitation Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Johan Swanik Rietman
- Roessingh Research and Development, Laboratory of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Armin Curt
- Spinal Cord Injury Centre, Balgrist University Hospital, Zurich, Switzerland
- European Multicenter Study about Human Spinal Cord Injury (EM SCI), Zurich, Switzerland
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Editorial note on: agreement of repeated motor and sensory scores at individual myotomes and dermatomes in young persons with spinal cord injury. Spinal Cord 2012; 51:82. [PMID: 23147132 DOI: 10.1038/sc.2012.129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Haefeli J, Curt A. Refined sensory measures of neural repair in human spinal cord injury: bridging preclinical findings to clinical value. Cell Tissue Res 2012; 349:397-404. [PMID: 22427116 DOI: 10.1007/s00441-012-1373-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 02/14/2012] [Indexed: 10/28/2022]
Abstract
Sensory input from the periphery to the brain can be severely compromised or completely abolished after an injury to the spinal cord. Evidence from animal models suggests that endogenous repair processes in the spinal cord mediate extensive sprouting and that this might be further attenuated by targeted therapeutic interventions. However, the extent to which sprouting can contribute to spontaneous recovery after human spinal cord injury (SCI) remains largely unknown, in part because few measurement tools are available in order to non-invasively detect subtle changes in neurophysiology. The proposed application of segmental sensory evoked potentials (e.g., dermatomal contact heat evoked potentials and somatosensory evoked potentials) to assess conduction in ascending pathways (i.e., spinothalamic and dorsal column, respectively) differs from conventional approaches in that individual spinal segments adjacent to the level of lesion are examined. The adoption of these approaches into clinical research might provide improved resolution for measuring changes in sensory impairments and might determine the extent by which spontaneous recovery after SCI is mediated by similar endogenous repair mechanisms in humans as in animal models.
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Affiliation(s)
- Jenny Haefeli
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland
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