1
|
Pfyffer D, Smith AC, Weber KA, Grillhoesl A, Mach O, Draganich C, Berliner JC, Tefertiller C, Leister I, Maier D, Schwab JM, Thompson A, Curt A, Freund P. Prognostic value of tissue bridges in cervical spinal cord injury: a longitudinal, multicentre, retrospective cohort study. Lancet Neurol 2024:S1474-4422(24)00173-X. [PMID: 38945142 DOI: 10.1016/s1474-4422(24)00173-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 02/21/2024] [Accepted: 04/17/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND The accuracy of prognostication in patients with cervical spinal cord injury (SCI) needs to be improved. We aimed to explore the prognostic value of preserved spinal tissue bridges-injury-spared neural tissue adjacent to the lesion-for prediction of sensorimotor recovery in a large, multicentre cohort of people with SCI. METHODS For this longitudinal study, we included patients with acute cervical SCI (vertebrae C1-C7) admitted to one of three trauma or rehabilitation centres: Murnau, Germany (March 18, 2010-March 1, 2021); Zurich, Switzerland (May 12, 2002-March 2, 2019); and Denver, CO, USA (Jan 12, 2010-Feb 16, 2017). Patients were clinically assessed at admission (baseline), at discharge (3 months), and at 12 months post SCI. Midsagittal tissue bridges were quantified from T2-weighted images assessed at 3-4 weeks post SCI. Fractional regression and unbiased recursive partitioning models, adjusted for age, sex, centre, and neurological level of injury, were used to assess associations between tissue bridge width and baseline-adjusted total motor score, pinprick score, and light touch scores at 3 months and 12 months. Patients were stratified into subgroups according to whether they showed better or worse predicted recovery. FINDINGS The cohort included 227 patients: 93 patients from Murnau (22 [24%] female); 43 patients from Zurich (four [9%] female); and 91 patients from Denver (14 [15%] female). 136 of these participants (from Murnau and Zurich) were followed up for up to 12 months. At 3 months, per preserved 1 mm of tissue bridge at baseline, patients recovered a mean of 9·3% (SD 0·9) of maximal total motor score (95% CI 7·5-11.2), 8·6% (0·8) of maximal pinprick score (7·0-10·1), and 10·9% (0·8) of maximal light touch score (9·4-12·5). At 12 months post SCI, per preserved 1 mm of tissue bridge at baseline, patients recovered a mean of 10·9% (1·3) of maximal total motor score (8·4-13·4), 5·7% (1·3) of maximal pinprick score (3·3-8·2), and 6·9% (1·4) of maximal light touch score (4·1-9·7). Partitioning models identified a tissue bridge cutoff width of 2·0 mm to be indicative of higher or lower 3-month total motor, pinprick, and light touch scores, and a cutoff of 4·0 mm to be indicative of higher and lower 12-month scores. Compared with models that contained clinical predictors only, models additionally including tissue bridges had significantly improved prediction accuracy across all three centres. INTERPRETATION Tissue bridges, measured in the first few weeks after SCI, are associated with short-term and long-term clinical improvement. Thus, tissue bridges could potentially be used to guide rehabilitation decision making and to stratify patients into more homogeneous subgroups of recovery in regenerative and neuroprotective clinical trials. FUNDING Wings for Life, International Foundation for Research in Paraplegia, EU project Horizon 2020 (NISCI grant), and ERA-NET NEURON.
Collapse
Affiliation(s)
- Dario Pfyffer
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Andrew C Smith
- Craig Hospital, Englewood, CO, USA; Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kenneth A Weber
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Orpheus Mach
- Spinal Cord Injury Center, BG Trauma Center Murnau, Murnau, Germany
| | | | | | | | - Iris Leister
- Spinal Cord Injury Center, BG Trauma Center Murnau, Murnau, Germany; Paramove, SCI Research Unit, BG Trauma Center Murnau, Murnau, Germany; Institute of Molecular Regenerative Medicine and Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Doris Maier
- Spinal Cord Injury Center, BG Trauma Center Murnau, Murnau, Germany
| | - Jan M Schwab
- Department of Neurology, Department of Physical Medicine and Rehabilitation, and Department of Neuroscience, Belford Center for Spinal Cord Injury, Wexner Medical School, The Ohio State University, Columbus, OH, USA; Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Alan Thompson
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Patrick Freund
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK; Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, London, UK; Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
| |
Collapse
|
2
|
Mputu Mputu P, Beauséjour M, Richard-Denis A, Fallah N, Noonan VK, Mac-Thiong JM. Classifying clinical phenotypes of functional recovery for acute traumatic spinal cord injury. An observational cohort study. Disabil Rehabil 2024:1-8. [PMID: 38390856 DOI: 10.1080/09638288.2024.2320267] [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: 04/18/2023] [Accepted: 02/14/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE Identify patient subgroups with different functional outcomes after SCI and study the association between functional status and initial ISNCSCI components. METHODS Using CART, we performed an observational cohort study on data from 675 patients enrolled in the Rick-Hansen Registry(RHSCIR) between 2014 and 2019. The outcome was the Spinal Cord Independence Measure (SCIM) and predictors included AIS, NLI, UEMS, LEMS, pinprick(PPSS), and light touch(LTSS) scores. A temporal validation was performed on data from 62 patients treated between 2020 and 2021 in one of the RHSCIR participating centers. RESULTS The final CART resulted in four subgroups with increasing totSCIM according to PPSS, LEMS, and UEMS: 1)PPSS < 27(totSCIM = 28.4 ± 16.3); 2)PPSS ≥ 27, LEMS < 1.5, UEMS < 45(totSCIM = 39.5 ± 19.0); 3)PPSS ≥ 27, LEMS < 1.5, UEMS ≥ 45(totSCIM = 57.4 ± 13.8); 4)PPSS ≥ 27, LEMS ≥ 1.5(totSCIM = 66.3 ± 21.7). The validation model performed similarly to the original model. The adjusted R-squared and F-test were respectively 0.556 and 62.2(P-value <0.001) in the development cohort and, 0.520 and 31.9(P-value <0.001) in the validation cohort. CONCLUSION Acknowledging the presence of four characteristic subgroups of patients with distinct phenotypes of functional recovery based on PPSS, LEMS, and UEMS could be used by clinicians early after tSCI to plan rehabilitation and establish realistic goals. An improved sensory function could be key for potentiating motor gains, as a PPSS ≥ 27 was a predictor of a good function.
Collapse
Affiliation(s)
- Pascal Mputu Mputu
- Hôpital du Sacré-Cœur de Montréal/CIUSSS NÎM, Montreal, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Marie Beauséjour
- Department of Community Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
- CHU Sainte-Justine, Montreal, Canada
| | - Andréane Richard-Denis
- Hôpital du Sacré-Cœur de Montréal/CIUSSS NÎM, Montreal, Canada
- Centre de recherche interdisciplinaire en réadaptation (CRIR), Montreal, Canada
| | - Nader Fallah
- Praxis Spinal Cord Institute, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Vanessa K Noonan
- Praxis Spinal Cord Institute, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Jean-Marc Mac-Thiong
- Hôpital du Sacré-Cœur de Montréal/CIUSSS NÎM, Montreal, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Canada
| |
Collapse
|
3
|
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.
Collapse
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.)
| |
Collapse
|
4
|
Independence and upper extremity functioning after spinal cord injury: a cross-sectional study. Sci Rep 2023; 13:3148. [PMID: 36823179 PMCID: PMC9950049 DOI: 10.1038/s41598-023-29986-y] [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: 05/30/2022] [Accepted: 02/14/2023] [Indexed: 02/25/2023] Open
Abstract
Upper extremity functioning is important for achieving independence in activities of daily living (ADL). A better understanding of relationships between different aspects of independence in ADL after spinal cord injury (SCI) and upper extremity functioning is required to guide rehabilitation practices. To determine which aspects of independence in ADL are correlated with upper extremity functioning in individuals with cervical or thoracic SCI. A total of 25 adults (mean age 58.4 years, 72% men) with established cervical or thoracic SCI were recruited. Independence in ADL was assessed by Spinal Cord Independence Measure (SCIM-III) and upper extremity functioning by kinematic measures (movement time, smoothness, and wrist angle during drinking task), grip strength, Upper Extremity Motor and Sensory Score, Box and Block Test (BBT), Action Research Arm Test (ARAT), and Upper Extremity Basic Data Set (ISCI-Hand and ISCI-Shoulder). Spearman correlation coefficients were used for data analyses. The SCIM-self-care subscale, particularly the feeding and dressing items, correlated moderately (r ≥ 0.5) with movement time and smoothness, grip strength, ARAT, BBT, and ISCI-Hand. The SCIM-respiration/sphincter subscale and the SCIM-mobility showed very low and low correlations with upper extremity assessments. However, at item level, respiration and bed/wheelchair mobility showed moderate correlations. Independence in self-care as domain and feeding/dressing, respiration and bed/wheelchair mobility as separate items were dependent on upper extremity functioning in individuals with cervical or thoracic SCI. Movement time and smoothness along with BBT, grip strength, ARAT, and ISCI-Hand can be used as indicators of independence in ADL. These findings can provide guidance to clinical practice in selection of upper extremity assessments in the context for ADL in individuals with SCI.
Collapse
|
5
|
Voss S, Adighibe A, Sanders E, Aaby D, Kravitt R, Clark G, Breen K, Barry A, Forrest GF, Kirshblum SC, Perez MA, Kalsi-Ryan S, Kocherginsky M, Rymer WZ, Sandhu MS. Development of a Remote Version of the Graded Redefined Assessment of Strength, Sensation, and Prehension (GRASSP): Validity and Reliability. Neurorehabil Neural Repair 2023; 37:83-93. [PMID: 36987396 PMCID: PMC10939131 DOI: 10.1177/15459683231162830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
BACKGROUND The Graded Redefined Assessment of Strength, Sensation, and Prehension (GRASSP V1.0) was developed in 2010 as a 3-domain assessment for upper extremity function after tetraplegia (domains: Strength, Sensibility, and Prehension). A remote version (rGRASSP) was created in response to the growing needs of the field of Telemedicine. OBJECTIVE The purpose of this study was to assess the psychometric properties of rGRASSP, establishing concurrent validity and inter-rater reliability. METHODS Individuals with tetraplegia (n = 61) completed 2 visits: 1 in-person and 1 remote. The first visit was completed in-person to administer the GRASSP, and the second visit was conducted remotely to administer the rGRASSP. The rGRASSP was scored both by the administrator of the rGRASSP (Examiner 1), and a second assessor (Examiner 2) to establish inter-rater reliability. Agreement between the in-person and remote GRASSP evaluations was assessed using the intraclass correlation coefficient (ICC) and Bland-Altman agreement plots. RESULTS The remote GRASSP demonstrated excellent concurrent validity with the GRASSP (left hand intraclass correlation coefficient (ICC) = .96, right ICC = .96). Concurrent validity for the domains was excellent for strength (left ICC = .96, right ICC = .95), prehension ability (left ICC = .94, right ICC = .95), and prehension performance (left ICC = .92, right ICC = .93), and moderate for sensibility (left ICC = .59, right ICC = .68). Inter-rater reliability for rGRASSP total score was high (ICC = .99), and remained high for all 4 domains. Bland-Altman plots and limits of agreements support these findings. CONCLUSIONS The rGRASSP shows strong concurrent validity and inter-rater reliability, providing a psychometrically sound remote assessment for the upper extremity in individuals with tetraplegia.
Collapse
Affiliation(s)
| | | | | | - David Aaby
- Department of Preventative Medicine, Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Gina Clark
- Shirley Ryan Ability Lab, Chicago, IL, USA
| | | | | | - Gail F. Forrest
- Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Steve C. Kirshblum
- Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Monica A. Perez
- Shirley Ryan Ability Lab, Chicago, IL, USA
- Edward Hines Jr. VA Hospital, Hines, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Masha Kocherginsky
- Department of Preventative Medicine, Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - William Zev Rymer
- Shirley Ryan Ability Lab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Milap S. Sandhu
- Shirley Ryan Ability Lab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|
6
|
Kalsi-Ryan S, Balbinot G, Wang JZ, Abel R, Bolliger M, Curt A, Fehlings MG, Jin D, Verrier M, Velstra IM. Minimal Clinically Important Difference of Graded Redefined Assessment of Strength, Sensibility, and Prehension Version 1 in Acute Cervical Traumatic Spinal Cord Injury. J Neurotrauma 2022; 39:1645-1653. [PMID: 35652348 DOI: 10.1089/neu.2021.0500] [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: 01/06/2023] Open
Abstract
The Graded Redefined Assessment of Strength, Sensibility, and Prehension Version 1 (GRASSP v1) is a validated measure of upper extremity impairment shown to be sensitive and responsive for traumatic cervical spinal cord injury (SCI) in both North American (NA) and European (EU) cohorts. The minimal clinically important difference (MCID) is the quantitative change in an assessment scale that patients perceive as being beneficial. Our aim was to establish the MCID of all subtests of the GRASSP v1 for cervical SCI. We prospectively analyzed 127 patients from NA and EU for up to six months after motor complete and incomplete cervical SCI using the GRASSP v1, Spinal Cord Independence Measure, and International Standards of Neurological Classification of Spinal Cord Injury. We used a patient global rating of change and the anchor-based method to calculate MCID of GRASSP v1 at six months post-injury. The MCID was established for the whole group, dividing the sample by "better" and "much better." Improvement in GRASSP v1 Strength and Prehension Performance scores of 13 and 3 are the MCID for the better category, and 19 and 7 are the MCID for the much better category, respectively. The MCID was also established for the motor complete and incomplete groups. Improvement in GRASSP v1 Strength and Prehension Performance scores of 12 and 6 are the MCID for the motor complete group, and 17 and 12 are the MCID for the motor incomplete group, respectively. The GRASSP v1 Strength subscore is the most sensitive for detecting meaningful clinical change in patients and is most closely related to measures of independence. Thus, use of GRASSP v1 Strength and Prehension Performance as measures of change is substantiated by this study.
Collapse
Affiliation(s)
- Sukhvinder Kalsi-Ryan
- Toronto Rehabilitation Institute-UHN, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Department of Physical Therapy, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, Toronto, Ontario, Canada
| | | | - Justin Zhang Wang
- University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, Toronto, Ontario, Canada
| | - Rainer Abel
- Spinal Cord Injury Centre, Hohe Warte, Bayreuth, Germany.,European Multicenter Study about Human Spinal Cord Injury, Zurich, Switzerland
| | - Marc Bolliger
- Spinal Cord Injury Centre, University Hospital Balgrist, Zurich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Centre, University Hospital Balgrist, Zurich, Switzerland
| | - Michael G Fehlings
- University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, Toronto, Ontario, Canada.,Krembil Neuroscience Centre, Toronto, Ontario, Canada
| | - Daniel Jin
- Toronto Rehabilitation Institute-UHN, Toronto, Ontario, Canada.,University of Waterloo, Waterloo, Ontario, Canada
| | - Mary Verrier
- Toronto Rehabilitation Institute-UHN, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Department of Physical Therapy, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, Toronto, Ontario, Canada
| | - Inge-Marie Velstra
- European Multicenter Study about Human Spinal Cord Injury, Zurich, Switzerland.,Swiss Paraplegic Centre, Knotwil, Switzerland
| |
Collapse
|
7
|
Berger MJ, Adewuyi AA, Fox IK, Franz CK. Clinical electrodiagnostic evaluation for nerve transfer surgery in spinal cord injury: a new indication and clinical pearls. J Neurophysiol 2022; 128:847-853. [PMID: 36043801 PMCID: PMC10190829 DOI: 10.1152/jn.00289.2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 11/22/2022] Open
Abstract
In this review, we highlight the important role of the clinical electrodiagnostic (EDX) evaluation after cervical spinal cord injury (SCI). Our discussion focuses on the need for timely, frequent, and accurate EDX evaluations in the context of nerve transfer surgery to restore critical upper limb functions, including elbow extension, hand opening, and hand closing. The EDX evaluation is crucial to define the extent of lower motor neuron lesions and determine candidacy for surgery. We also discuss the important role of the postoperative EDX evaluation in determining prognosis and supporting rehabilitation. We propose a practical framework for EDX evaluation in this clinical setting.
Collapse
Affiliation(s)
- Michael J Berger
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Physical Medicine & Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adenike A Adewuyi
- Regenerative Neurorehabilitation Laboratory, Shirley Ryan AbilityLab, Chicago, Illinois
- Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ida K Fox
- Division of Plastic Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Colin K Franz
- Regenerative Neurorehabilitation Laboratory, Shirley Ryan AbilityLab, Chicago, Illinois
- Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
8
|
Thomé C, Kögl N, Grassner L, Vo AK, Kramer JLK, Petr O. Motor Recovery Depends on Timing of Surgery in Patients With Lumbar Disk Herniation. Neurosurgery 2022; 90:347-353. [PMID: 35040807 DOI: 10.1227/neu.0000000000001825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/17/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although approximately half of the patients undergoing lumbar disk surgery present with motor deficits, timing of surgery for radicular weakness is largely unclear. OBJECTIVE To evaluate the impact of surgical timing on motor recovery in patients with lumbar disk herniation (LDH) and to identify an ideal time window for intervention. METHODS In a single-center observational trial, 390 patients with LDH-associated motor deficits were prospectively followed for a minimum of 12 months after nonelective microscopic disk surgery. The duration of motor deficit before surgery was documented. Motor function was graded according to the Medical Research Council (MRC) scale. Statistical analysis of motor recovery applied unbiased recursive partitioning conditional inference tree to determine cutoff times for optimal surgical intervention. The slope of recovery calculated as the change of the MRC grade over time served as the primary outcome. RESULTS A preoperative motor deficit of MRC ≤2/5 and the duration of paresis were identified as the most important predictors of recovery ( P < .001). Surgery within 3 days was associated with a better recovery for both severe and moderate/mild deficits ( P = .017 for MRC ≤ 2/5; P < .001 for MRC > 2/5; number needed to treat [NNT] <2). A sensitivity analysis in mild motor deficits indicated a cutoff of 8 days. CONCLUSION Timing of surgery is crucial for motor recovery in LDH-associated deficits. Immediate diagnosis, imaging, and referral should be aimed for to allow disk surgery within 3 days in patients with severe and moderate radicular weakness. If functionally disabling, even mild deficits may warrant decompression within a week.
Collapse
Affiliation(s)
- Claudius Thomé
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Nikolaus Kögl
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Lukas Grassner
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Anh Khoa Vo
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
| | | | - Ondra Petr
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| |
Collapse
|
9
|
Lili L, Sunnerhagen KS, Rekand T, Alt Murphy M. Associations between upper extremity functioning and kinematics in people with spinal cord injury. J Neuroeng Rehabil 2021; 18:147. [PMID: 34565401 PMCID: PMC8474732 DOI: 10.1186/s12984-021-00938-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 09/08/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction More knowledge of the relationships between kinematic measures and clinical assessments is required to guide clinical decision making and future research. Objectives To determine which kinematic variables obtained during a drinking task were associated with clinical assessments of upper extremity functioning in people with spinal cord injury (SCI). Methods In total, 25 individuals with chronic cervical (n = 17) or thoracic (n = 8) complete (n = 14) or motor incomplete (n = 11) SCI (mean age 58.4, SD 13.8) were included. Kinematic data, including movement time, smoothness and joint angles was captured with a 5-camera optoelectronic system during a unimanual drinking task. Action Research Arm Test (ARAT), Sollerman Hand Function Test (SHFT) and basic hand classification of the Upper Extremity Data Set (ISCI-Hand) were used as clinical assessments. Multiple regression analysis was used to identify kinematic variables associated with clinical assessments after controlling for potential confounding factors, such as, age, severity of SCI, sensory function, and hand surgery. Results Movement time, smoothness and movement pattern kinematics including trunk displacement, elbow and wrist joint angles were correlated (p < 0.05) with all three clinical scales while the velocity-related kinematics and inter-joint coordination showed low correlations. Multiple regression analysis revealed that wrist angle combined with movement time or smoothness explained 82% and 77% of the total variance in ARAT and SHFT, respectively. Wrist angle alone explained 59% of the variance in ISCI-Hand. The proprioception of the hand increased the explanatory power in the models of ARAT and SHFT. Associations between kinematics and clinical assessments in the subgroup with cervical SCI were equivalent to the whole group analyses. The number of participants in the subgroup with thoracic SCI was small and only allowed limited analysis. Conclusions Wrist angle, movement time, movement smoothness are the most important kinematic variables associated with upper extremity clinical assessments in people with SCI. The results are most valid for individuals with cervical SCI. All three assessments are appropriate for SCI. Further research with larger representative sample of thoracic SCI needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00938-9.
Collapse
Affiliation(s)
- Lamprini Lili
- Institute of Neuroscience and Physiology, Clinical Neuroscience, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Per Dubbsgatan 14, 3rd Floor, 41345, Göteborg, Sweden. .,Department of Neurological Rehabilitation, Sahlgrenska University Hospital, Göteborg, Sweden.
| | - Katharina S Sunnerhagen
- Institute of Neuroscience and Physiology, Clinical Neuroscience, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Per Dubbsgatan 14, 3rd Floor, 41345, Göteborg, Sweden.,Department of Neurological Rehabilitation, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Tiina Rekand
- Institute of Neuroscience and Physiology, Clinical Neuroscience, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Per Dubbsgatan 14, 3rd Floor, 41345, Göteborg, Sweden.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Margit Alt Murphy
- Institute of Neuroscience and Physiology, Clinical Neuroscience, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Per Dubbsgatan 14, 3rd Floor, 41345, Göteborg, Sweden.,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Göteborg, Sweden
| |
Collapse
|
10
|
Pavese C, Scivoletto G, Puci MV, Schubert M, Curt A, Finazzi Agrò E, Montomoli C, Kessler TM. External Validation Confirms Validity of a Simple Model to Predict Bowel Outcome After Traumatic Spinal Cord Injury. Neurorehabil Neural Repair 2021; 35:659-662. [PMID: 34114519 DOI: 10.1177/15459683211023191] [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: 11/15/2022]
Abstract
Background. The prediction of functional outcomes after spinal cord injury (SCI) is essential to plan the rehabilitation phase and the social reintegration. Recently, 2 models to predict independent and reliable bowel management 1 year after traumatic SCI have been derived and validated in 2 cohorts of patients included in the European Multicenter Study about Spinal Cord Injury (EMSCI). Objective. We aimed to validate 2 prediction models for bowel outcome after traumatic SCI in a patient sample external to EMSCI. Methods. The simplified model (based on a single predictor, the International Standards for Neurological Classification of Spinal Cord Injury [ISNCSCI] total motor score) and the full model (based on 2 predictors, the ISNCSCI total motor score and item 3a of the Spinal Cord Independence Measure) were applied to the retrospectively collected data of 111 patients with traumatic SCI. Results. The simplified and the full models showed excellent discrimination with an area under the receiver operating characteristic curve of .939 (95% confidence interval (CI) .87-1.00) and .922 (95% CI 0.85-.99), respectively. Both models displayed similar results for sensitivity and negative predictive values; however, the simplified model showed higher values for specificity, positive predictive values, and accuracy. The calibration analysis showed a partial overlap between predicted probabilities and observed proportion, with better and acceptable calibration for the simplified model. Conclusions. Using an independent sample, our study demonstrates the validity of a simple model to predict independent and reliable bowel management 1 year after traumatic SCI.
Collapse
Affiliation(s)
- Chiara Pavese
- Neurology, Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Switzerland.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy.,Neurorehabilitation Unit, IRCCS ICS Maugeri Spa-SB, Pavia, Italy
| | - Giorgio Scivoletto
- Spinal Cord Unit and Spinal Rehabilitation (SpiRe) Lab, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Mariangela V Puci
- Unit of Bio Statistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - Martin Schubert
- Neurology, Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Switzerland
| | - Armin Curt
- Neurology, Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Switzerland
| | - Enrico Finazzi Agrò
- Department of Surgical Sciences, Tor Vergata University, Rome, Italy.,Department of Urology, Policlinico Tor Vergata, Rome, Italy
| | - Cristina Montomoli
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Switzerland
| |
Collapse
|
11
|
Buri M, Tanadini LG, Hothorn T, Curt A. Unbiased Recursive Partitioning Enables Robust and Reliable Outcome Prediction in Acute Spinal Cord Injury. J Neurotrauma 2021; 39:266-276. [PMID: 33619988 DOI: 10.1089/neu.2020.7407] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Neurological disorders usually present very heterogeneous recovery patterns. Nonetheless, accurate prediction of future clinical end-points and robust definition of homogeneous cohorts are necessary for scientific investigation and targeted care. For this, unbiased recursive partitioning with conditional inference trees (URP-CTREE) have received increasing attention in medical research, especially, but not limited to traumatic spinal cord injuries (SCIs). URP-CTREE was introduced to SCI as a clinical guidance tool to explore and define homogeneous outcome groups by clinical means, while providing high accuracy in predicting future clinical outcomes. The validity and predictive value of URP-CTREE to provide improvements compared with other more common approaches applied by clinicians has recently come under critical scrutiny. Therefore, a comprehensive simulation study based on traumatic, cervical complete spinal cord injuries provides a framework to investigate and quantify the issues raised. First, we assessed the replicability and robustness of URP-CTREE to identify homogeneous subgroups. Second, we implemented a prediction performance comparison of URP-CTREE with traditional statistical techniques, such as linear or logistic regression, and a novel machine learning method. URP-CTREE's ability to identify homogeneous subgroups proved to be replicable and robust. In terms of prediction, URP-CTREE yielded a high prognostic performance comparable to a machine learning algorithm. The simulation study provides strong evidence for the robustness of URP-CTREE, which is achieved without compromising prediction accuracy. The slightly lower prediction performance is offset by URP-CTREE's straightforward interpretation and application in clinical settings based on simple, data-driven decision rules.
Collapse
Affiliation(s)
- Muriel Buri
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zürich, Switzerland
| | - Lorenzo G Tanadini
- School of Agricultural, Forest and Food Sciences, Bern University of Applied Sciences, Bern, Switzerland
| | - Torsten Hothorn
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zürich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zürich, Switzerland
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Pfyffer D, Vallotton K, Curt A, Freund P. Predictive Value of Midsagittal Tissue Bridges on Functional Recovery After Spinal Cord Injury. Neurorehabil Neural Repair 2020; 35:33-43. [PMID: 33190619 PMCID: PMC8350965 DOI: 10.1177/1545968320971787] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background The majority of patients with spinal cord injury (SCI) have anatomically incomplete lesions and present with preserved tissue bridges, yet their outcomes vary. Objective To assess the predictive value of the anatomical location (ventral/dorsal) and width of preserved midsagittal tissue bridges for American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade conversion and SCI patient stratification into recovery-specific subgroups. Methods This retrospective longitudinal study includes 70 patients (56 men, age: 52.36 ± 18.58 years) with subacute (ie, 1 month) SCI (45 tetraplegics, 25 paraplegics), 1-month neuroimaging data, and 1-month and 12-month clinical data. One-month midsagittal T2-weighted scans were used to determine the location and width of tissue bridges. Their associations with functional outcomes were assessed using partial correlation and unbiased recursive partitioning conditional inference tree (URP-CTREE). Results Fifty-seven (81.4%) of 70 patients had tissue bridges (2.53 ± 2.04 mm) at 1-month post-SCI. Larger ventral (P = .001, r = 0.511) and dorsal (P < .001, r = 0.546) tissue bridges were associated with higher AIS conversion rates 12 months post-SCI (n = 39). URP-CTREE analysis identified 1-month ventral tissue bridges as predictors of 12-month total motor scores (0.4 mm cutoff, P = .008), recovery of upper extremity motor scores at 12 months (1.82 mm cutoff, P = .002), 12-month pin-prick scores (1.4 mm cutoff, P = .018), and dorsal tissue bridges at 1 month as predictors of 12-month Spinal Cord Independence Measure scores (0.5 mm cutoff, P = .003). Conclusions Midsagittal tissue bridges add predictive value to baseline clinical measures for post-SCI recovery. Based on tissue bridges’ width, patients can be classified into subgroups of clinical recovery profiles. Midsagittal tissue bridges provide means to optimize patient stratification in clinical trials.
Collapse
Affiliation(s)
- Dario Pfyffer
- Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Kevin Vallotton
- Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Armin Curt
- Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Patrick Freund
- Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,Wellcome Trust Center for Neuroimaging, UCL Institute of Neurology, University College London, London, UK.,Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| |
Collapse
|
14
|
Pfyffer D, Vallotton K, Curt A, Freund P. Tissue bridges predict neuropathic pain emergence after spinal cord injury. J Neurol Neurosurg Psychiatry 2020; 91:1111-1117. [PMID: 32788257 PMCID: PMC7509517 DOI: 10.1136/jnnp-2020-323150] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/26/2020] [Accepted: 06/17/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess associations between preserved spinal cord tissue quantified by the width of ventral and dorsal tissue bridges and neuropathic pain development after spinal cord injury. METHODS This retrospective longitudinal study includes 44 patients (35 men; mean (SD) age, 50.05 (18.88) years) with subacute (ie, 1 month) spinal cord injury (25 patients with neuropathic pain, 19 pain-free patients) and neuroimaging data who had a follow-up clinical assessment at 12 months. Widths of tissue bridges were calculated from midsagittal T2-weighted images and compared across groups. Regression analyses were used to identify relationships between these neuroimaging measures and previously assessed pain intensity and pin-prick score. RESULTS Pin-prick score of the 25 patients with neuropathic pain increased from 1 to 12 months (Δmean=10.08, 95% CI 2.66 to 17.50, p=0.010), while it stayed similar in pain-free patients (Δmean=2.74, 95% CI -7.36 to 12.84, p=0.576). They also had larger ventral tissue bridges (Δmedian=0.80, 95% CI 0.20 to 1.71, p=0.008) at 1 month when compared with pain-free patients. Conditional inference tree analysis revealed that ventral tissue bridges' width (≤2.1 or >2.1 mm) at 1 month is the strongest predictor for 12 months neuropathic pain intensity (1.90±2.26 and 3.83±1.19, p=0.042) and 12 months pin-prick score (63.84±28.26 and 92.67±19.43, p=0.025). INTERPRETATION Larger width of ventral tissue bridges-a proxy for spinothalamic tract function-at 1 month post-spinal cord injury is associated with the emergence and maintenance of neuropathic pain and increased pin-prick sensation. Spared ventral tissue bridges could serve as neuroimaging biomarkers of neuropathic pain and might be used for prediction and monitoring of pain outcomes and stratification of patients in interventional trials.
Collapse
Affiliation(s)
- Dario Pfyffer
- Spinal Cord Injury Center, University Hospital Balgrist, Zurich, Switzerland
| | - Kevin Vallotton
- Spinal Cord Injury Center, University Hospital Balgrist, Zurich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, University Hospital Balgrist, Zurich, Switzerland
| | - Patrick Freund
- Spinal Cord Injury Center, University Hospital Balgrist, Zurich, Switzerland .,Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, United Kingdom.,Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, University College London, London, United Kingdom.,Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| |
Collapse
|
15
|
Khan O, Badhiwala JH, Fehlings MG. Prediction of independence in bowel function after spinal cord injury: validation of a logistic regression model. Spinal Cord 2020; 59:207-214. [PMID: 32963361 PMCID: PMC7870806 DOI: 10.1038/s41393-020-00551-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/19/2020] [Accepted: 09/03/2020] [Indexed: 02/06/2023]
Abstract
STUDY DESIGN Retrospective analysis of prospectively collected data. OBJECTIVES Recently, logistic regression models were developed to predict independence in bowel function 1 year after spinal cord injury (SCI) on a multicenter European SCI (EMSCI) dataset. Here, we evaluated the external validity of these models against a prospectively accrued North American SCI dataset. SETTING Twenty-five SCI centers in the United States and Canada. METHODS Two logistic regression models developed by the EMSCI group were applied to data for 277 patients derived from three prospective multicenter SCI studies based in North America. External validation was evaluated for both models by assessing their discrimination, calibration, and clinical utility. Discrimination and calibration were assessed using ROC curves and calibration curves, respectively, while clinical utility was assessed using decision curve analysis. RESULTS The simplified logistic regression model, which used baseline total motor score as the predictor, demonstrated the best performance, with an area under the ROC curve of 0.869 (95% confidence interval: 0.826-0.911), a sensitivity of 75.5%, and a specificity of 88.5%. Moreover, the model was well calibrated across the full range of observed probabilities and displayed superior clinical benefit on the decision curve. CONCLUSIONS A logistic regression model using baseline total motor score as a predictor of independent bowel function 1 year after SCI was successfully validated against an external dataset. These findings provide evidence supporting the use of this model to enhance the care for individuals with SCI.
Collapse
Affiliation(s)
- Omar Khan
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jetan H Badhiwala
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Michael G Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada. .,Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
| |
Collapse
|
16
|
Vo AK, Geisler F, Grassner L, Schwab J, Whiteneck G, Jutzeler C, Kramer JLK. Serum albumin as a predictor of neurological recovery after spinal cord injury: a replication study. Spinal Cord 2020; 59:282-290. [PMID: 32839519 DOI: 10.1038/s41393-020-00536-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN This was a secondary analysis on an observational cohort study. OBJECTIVE To determine if serum albumin significantly associates with long-term neurological outcome (i.e., 1-year post-injury) in a contemporary cohort of individuals with spinal cord injury. SETTING Six rehabilitation centers across the United States. METHODS A secondary analysis of neurological outcomes and serum albumin concentrations was performed on data from the Spinal Cord Injury Rehabilitation study. Data was accessed from the Archive of Data on Disability to Enable Policy and research (ADDEP). The primary analysis applied unbiased recursive partitioning to examine the relationship between serum albumin, injury severity, and long-term outcomes. The analysis is accessible via https://rpubs.com/AnhKhoaVo/586028 . RESULTS Serum albumin concentration was significantly associated with lower extremity motor scores (LEMS) and American Spinal Injury Association Impairment Scale (AIS) grade at admission to rehabilitation. Serum albumin concentrations alone were also significantly associated with change of LEMS and marked recovery (improvement of at least 2 AIS grades and/or recovery to walking) at 1-year post injury. However, after adjusting for admission to rehabilitation LEMS and AIS grade, serum albumin was not significant. CONCLUSION The current study partially confirms our previous observations that serum albumin concentrations are associated with neurological outcome after spinal cord injury. As a crude prognostic biomarker, serum albumin concentration could be useful in cases where injury severity cannot be accurately assessed.
Collapse
Affiliation(s)
- Anh K Vo
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.,School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Fred Geisler
- University of Saskatchewan, Saskatoon, SK, Canada
| | - Lukas Grassner
- Center for Spinal Cord Injuries, BG Trauma Center Murnau, Murnau, Germany.,Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria.,Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Jan Schwab
- Belford Center for Spinal Cord Injury and Department of Neurology (Paraplegiology), Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | | | - Catherine Jutzeler
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.,Spinal Cord Injury Center, University Hospital Balgrist, Zurich, Switzerland.,Department of Biosystems Science and Engineering, ETH Zurich, 4058, Basel, Switzerland
| | - John L K Kramer
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada. .,School of Kinesiology, University of British Columbia, Vancouver, BC, Canada.
| |
Collapse
|
17
|
Freund P, Seif M, Weiskopf N, Friston K, Fehlings MG, Thompson AJ, Curt A. MRI in traumatic spinal cord injury: from clinical assessment to neuroimaging biomarkers. Lancet Neurol 2019; 18:1123-1135. [DOI: 10.1016/s1474-4422(19)30138-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 03/22/2019] [Accepted: 03/28/2019] [Indexed: 01/18/2023]
|
18
|
Tomaschek R, Gemperli A, Rupp R, Geng V, Scheel-Sailer A. A systematic review of outcome measures in initial rehabilitation of individuals with newly acquired spinal cord injury: providing evidence for clinical practice guidelines. Eur J Phys Rehabil Med 2019; 55:605-617. [DOI: 10.23736/s1973-9087.19.05676-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
19
|
Pavese C, Bachmann LM, Schubert M, Curt A, Mehnert U, Schneider MP, Scivoletto G, Finazzi Agrò E, Maier D, Abel R, Weidner N, Rupp R, Kessels AG, Kessler TM. Bowel Outcome Prediction After Traumatic Spinal Cord Injury: Longitudinal Cohort Study. Neurorehabil Neural Repair 2019; 33:902-910. [DOI: 10.1177/1545968319868722] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background. Predicting functional outcomes after traumatic spinal cord injury (SCI) is essential for counseling, rehabilitation planning, and discharge. Moreover, the outcome prognosis is crucial for patient stratification when designing clinical trials. However, no valid prediction rule is currently available for bowel outcomes after a SCI. Objective. To generate a model for predicting the achievement of independent, reliable bowel management at 1 year after traumatic SCI. Methods. We performed multivariable logistic regression analyses of data for 1250 patients with traumatic SCIs that were included in the European Multicenter Study about Spinal Cord Injury. The resulting model was prospectively validated on data for 186 patients. As potential predictors, we evaluated age, sex, and variables from the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and the Spinal Cord Independence Measure (SCIM), measured within 40 days of the injury. A positive outcome at 1 year post-SCI was assessed with item 7 of the SCIM. Results. The model relied on a single predictor, the ISNCSCI total motor score—that is, the sum of muscle strengths in 5 key muscle groups in each limb. The area under the receiver operating characteristics curve (aROC) was 0.837 (95% CI: 0.815-0.859). The prospective validation confirmed high predictive power: aROC = 0.817 (95% CI: 0.754-0.881). Conclusions. We generated a valid model for predicting independent, reliable bowel management at 1 year after traumatic SCI. Its application could improve counseling, optimize patient-tailored rehabilitation planning, and become crucial for appropriate patient stratification in future clinical trials.
Collapse
Affiliation(s)
- Chiara Pavese
- Balgrist University Hospital, University of Zürich, Zürich, Switzerland
- University of Pavia, Pavia, Italy; Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | | | - Martin Schubert
- Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Armin Curt
- Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Ulrich Mehnert
- Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Marc P. Schneider
- Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | | | | | | | | | | | - Rüdiger Rupp
- Heidelberg University Hospital, Heidelberg, Germany
| | | | - Thomas M. Kessler
- Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| |
Collapse
|
20
|
Evaniew N, Fallah N, Rivers CS, Noonan VK, Fisher CG, Dvorak MF, Wilson JR, Kwon BK. Unbiased Recursive Partitioning to Stratify Patients with Acute Traumatic Spinal Cord Injuries: External Validity in an Observational Cohort Study. J Neurotrauma 2019; 36:2732-2742. [PMID: 30864876 PMCID: PMC6727480 DOI: 10.1089/neu.2018.6335] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Clinical trials of novel therapies for acute spinal cord injury (SCI) are challenging because variability in spontaneous neurologic recovery can make discerning actual treatment effects difficult. Unbiased Recursive Partitioning regression with Conditional Inference Trees (URP-CTREE) is a novel approach developed through analyses of a large European SCI database (European Multicenter Study about Spinal Cord Injury). URP-CTREE uses early neurologic impairment to predict achieved motor recovery, with potential to optimize clinical trial design by optimizing patient stratification and decreasing sample sizes. We performed external validation to determine how well a previously reported URP-CTREE model stratified patients into distinct homogeneous subgroups and predicted subsequent neurologic recovery in an independent cohort. We included patients with acute cervical SCI level C4-C6 from a prospective registry at a quaternary care center from 2004-2018 (n = 101) and applied the URP-CTREE model and evaluated Upper Extremity Motor Score (UEMS) recovery, considered correctly predicted when final UEMS scores were within a pre-specified threshold of 9 points from median; sensitivity analyses evaluated the effect of timing of baseline neurological examination. We included 101 patients, whose mean times from injury baseline and follow-up examinations were 6.1 days (standard deviation [SD] 17) and 235.0 days (SD 71), respectively. Median UEMS recovery was 7 points (interquartile range 2-12). One of the predictor variables was not statistically significant in our sample; one group did not fit progressively improving UEMS scores, and three of five groups had medians that were not significantly different from adjacent groups. Overall accuracy was 75%, but varied from 82% among participants whose examinations occurred at <12 h, to 64% at 12-24 h, and 58% at >24 h. A previous URP-CTREE model had limited ability to stratify an independent into homogeneous subgroups. Overall accuracy was promising, but may be sensitive to timing of baseline neurological examinations. Further evaluation of external validity in incomplete injuries, influence of timing of baseline examinations, and investigation of additional stratification strategies is warranted.
Collapse
Affiliation(s)
- Nathan Evaniew
- Department of Orthopedics, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Spine Surgery Institute, Vancouver, British Columbia, Canada
| | - Nader Fallah
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - Carly S Rivers
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | | | - Charles G Fisher
- Department of Orthopedics, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Spine Surgery Institute, Vancouver, British Columbia, Canada
| | - Marcel F Dvorak
- Department of Orthopedics, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Spine Surgery Institute, Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Jefferson R Wilson
- Division of Neurosurgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Brian K Kwon
- Department of Orthopedics, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Spine Surgery Institute, Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
21
|
Decreased white matter fractional anisotropy is associated with poorer functional motor skills following spinal cord injury: a pilot study. Spinal Cord 2018; 57:206-213. [DOI: 10.1038/s41393-018-0191-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/31/2018] [Accepted: 08/14/2018] [Indexed: 01/18/2023]
|
22
|
Kucher K, Johns D, Maier D, Abel R, Badke A, Baron H, Thietje R, Casha S, Meindl R, Gomez-Mancilla B, Pfister C, Rupp R, Weidner N, Mir A, Schwab ME, Curt A. First-in-Man Intrathecal Application of Neurite Growth-Promoting Anti-Nogo-A Antibodies in Acute Spinal Cord Injury. Neurorehabil Neural Repair 2018; 32:578-589. [DOI: 10.1177/1545968318776371] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background. Neutralization of central nervous system neurite growth inhibitory factors, for example, Nogo-A, is a promising approach to improving recovery following spinal cord injury (SCI). In animal SCI models, intrathecal delivery of anti-Nogo-A antibodies promoted regenerative neurite growth and functional recovery. Objective. This first-in-man study assessed the feasibility, safety, tolerability, pharmacokinetics, and preliminary efficacy of the human anti-Nogo-A antibody ATI355 following intrathecal administration in patients with acute, complete traumatic paraplegia and tetraplegia. Methods. Patients (N = 52) started treatment 4 to 60 days postinjury. Four consecutive dose-escalation cohorts received 5 to 30 mg/2.5 mL/day continuous intrathecal ATI355 infusion over 24 hours to 28 days. Following pharmacokinetic evaluation, 2 further cohorts received a bolus regimen (6 intrathecal injections of 22.5 and 45 mg/3 mL, respectively, over 4 weeks). Results. ATI355 was well tolerated up to 1-year follow-up. All patients experienced ≥1 adverse events (AEs). The 581 reported AEs were mostly mild and to be expected following acute SCI. Fifteen patients reported 16 serious AEs, none related to ATI355; one bacterial meningitis case was considered related to intrathecal administration. ATI355 serum levels showed dose-dependency, and intersubject cerebrospinal fluid levels were highly variable after infusion and bolus injection. In 1 paraplegic patient, motor scores improved by 8 points. In tetraplegic patients, mean total motor scores increased, with 3/19 gaining >10 points, and 1/19 27 points at Week 48. Conversion from complete to incomplete SCI occurred in 7/19 patients with tetraplegia. Conclusions. ATI335 was well tolerated in humans; efficacy trials using intrathecal antibody administration may be considered in acute SCI.
Collapse
Affiliation(s)
- Klaus Kucher
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Donald Johns
- Novartis Institutes for BioMedical Research Inc, Cambridge, MA, USA
| | - Doris Maier
- BG Trauma Center Murnau, Center for Spinal Cord Injury, Murnau, Germany
| | | | | | - Hagen Baron
- Eberhard Karls University, Tübingen, Germany
| | | | | | - Renate Meindl
- BG University Hospital Bergmannsheil, Ruhr-University, Bochum, Germany
| | - Baltazar Gomez-Mancilla
- Novartis Institutes for BioMedical Research, Basel, Switzerland
- McGill University, Montreal, Québec, Canada
| | | | - Rüdiger Rupp
- Heidelberg University Hospital, Heidelberg, Germany
| | | | - Anis Mir
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | | | - Armin Curt
- Balgrist University Hospital, Zurich, Switzerland
| |
Collapse
|
23
|
Velstra IM, Fellinghauer C, Abel R, Kalsi-Ryan S, Rupp R, Curt A. The Graded and Redefined Assessment of Strength, Sensibility, and Prehension Version 2 Provides Interval Measure Properties. J Neurotrauma 2018; 35:854-863. [PMID: 29160145 DOI: 10.1089/neu.2017.5195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Graded and Redefined Assessment of Strength, Sensibility and Prehension (GRASSP) is a valid, reliable, and responsive outcome measure to evaluate upper limb function in individuals with tetraplegia. GRASSP generates ordinal total scores; therefore, applicability as an interval level measurement requires testing of its measurement properties. This study examined the metric characteristics with Rasch Analysis to derive interval level scales of the respective GRASSP subtests. The GRASSP was recorded within 10 days, and at 1, 3, 6, and 12 months after cervical spinal cord injury (SCI). Rasch analysis was performed for each GRASSP subscale to assess the following metric assumptions: absence of local item dependency (LID), unidimensionality, monotonicity, item and model fit, reliability, and absence of differential item functioning (DIF) for side (left and right) and examination stage. If these assumptions could not be met, adjustments were undertaken to achieve a good fit to the Rasch model. Seventy-seven individuals with cervical SCI were included (n = 154 arms). Stacking the data for the side (left and right) resulted in a total of 614 observations, which were based on the repeated measurements. With minor adjustments, the GRASSP subscales showed good reliability, item fit, and ordered response options. Local item dependencies were found in the strength and sensibility subscales. Redundancies among some measurement items allowed shortening of the subscales without reasonable loss of reliability. Absence of DIF for the examination stage supported robustness of the subscales over time. The modified GRASSP, now Version 2, subtest scores can be applied as interval level measurements, and the reduction of items within subscales allows for shorter assessment times in clinical studies without degrading metric properties.
Collapse
Affiliation(s)
| | - Carolina Fellinghauer
- 2 Swiss Paraplegic Research (SPF), ICF Unit , Nottwil, Switzerland .,3 Department of Health Sciences and Health Policy, University of Lucerne , Lucerne, Switzerland
| | - Rainer Abel
- 4 Spinal Cord Injury Center , Hohe Warte, Bayreuth, Germany
| | - Sukhvinder Kalsi-Ryan
- 5 Toronto Rehabilitation Institute, University Health Network , Toronto, Ontario, Canada .,6 Department of Physical Therapy , University of Toronto , Toronto, Ontario, Canada
| | - Rüdiger Rupp
- 7 Klinik für Paraplegiologie, Universitätsklinikum Heidelberg , Heidelberg, Germany
| | - Armin Curt
- 8 Spinal Cord Injury Center, Balgrist University Hospital , Zurich, Switzerland
| |
Collapse
|
24
|
Fehlings MG, Kim KD, Aarabi B, Rizzo M, Bond LM, McKerracher L, Vaccaro AR, Okonkwo DO. Rho Inhibitor VX-210 in Acute Traumatic Subaxial Cervical Spinal Cord Injury: Design of the SPinal Cord Injury Rho INhibition InvestiGation (SPRING) Clinical Trial. J Neurotrauma 2018; 35:1049-1056. [PMID: 29316845 PMCID: PMC5908415 DOI: 10.1089/neu.2017.5434] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Traumatic spinal cord injury (SCI) is associated with a lifetime of disability stemming from loss of motor, sensory, and autonomic functions; these losses, along with increased comorbid sequelae, negatively impact health outcomes and quality of life. Early decompression surgery post-SCI can enhance patient outcomes, but does not directly facilitate neural repair and regeneration. Currently, there are no U.S. Food and Drug Administration-approved pharmacological therapies to augment motor function and functional recovery in individuals with traumatic SCI. After an SCI, the enzyme, Rho, is activated by growth-inhibitory factors and regulates events that culminate in collapse of the neuronal growth cone, failure of axonal regeneration, and, ultimately, failure of motor and functional recovery. Inhibition of Rho activation is a potential treatment for injuries such as traumatic SCI. VX-210, an investigational agent, inhibits Rho. When administered extradurally after decompression (corpectomy or laminectomy) and stabilization surgery in a phase 1/2a study, VX-210 was well tolerated. Here, we describe the design of the SPRING trial, a multicenter, phase 2b/3, randomized, double-blind, placebo-controlled clinical trial to evaluate the efficacy and safety of VX-210 (NCT02669849). A subset of patients with acute traumatic cervical SCI is currently being enrolled in the United States and Canada. Medical, neurological, and functional changes are evaluated at 6 weeks and at 3, 6, and 12 months after VX-210 administration. Efficacy will be assessed by the primary outcome measure, change in upper extremity motor score at 6 months post-treatment, and by secondary outcomes that include question-based and task-based evaluations of functional recovery.
Collapse
Affiliation(s)
- Michael G Fehlings
- 1 Division of Neurosurgery and Spine Program, University of Toronto , Toronto, Ontario, Canada
| | - Kee D Kim
- 2 Department of Neurological Surgery, University of California Davis School of Medicine , Sacramento, California
| | - Bizhan Aarabi
- 3 Department of Neurosurgery, University of Maryland School of Medicine , Baltimore, Maryland
| | - Marco Rizzo
- 4 Vertex Pharmaceuticals Incorporated , Boston, Massachusetts
| | - Lisa M Bond
- 5 BioAxone BioSciences, Inc , Cambridge, Massachusetts
| | | | - Alexander R Vaccaro
- 6 Department of Orthopaedic Surgery, Sidney Kimmel Medical Center at Thomas Jefferson University , Philadelphia, Pennsylvania
| | - David O Okonkwo
- 7 Department of Neurological Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
| |
Collapse
|
25
|
Use of optical motion capture for the analysis of normative upper body kinematics during functional upper limb tasks: A systematic review. J Electromyogr Kinesiol 2018. [PMID: 29533202 DOI: 10.1016/j.jelekin.2018.02.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Quantifying three-dimensional upper body kinematics can be a valuable method for assessing upper limb function. Considering that kinematic model characteristics, performed tasks, and reported outcomes are not consistently standardized and exhibit significant variability across studies, the purpose of this review was to evaluate the literature investigating upper body kinematics in non-disabled individuals via optical motion capture. Specific objectives were to report on the kinematic model characteristics, performed functional tasks, and kinematic outcomes, and to assess whether kinematic protocols were assessed for validity and reliability. Five databases were searched. Studies using anatomical and/or cluster marker sets, along with optical motion capture, and presenting normative data on upper body kinematics were eligible for review. Information extracted included model characteristics, performed functional tasks, kinematic outcomes, and validity or reliability testing. 804 publication records were screened and 20 reviewed based on the selection criteria. Thirteen studies described their kinematic protocols adequately for reproducibility, and 8 studies followed International Society of Biomechanics standards for quantifying upper body kinematics. Six studies assessed their protocols for validity or reliability. While a substantial number of studies have adequately reported their protocols, more systematic work is needed to evaluate the validity and reliability of existing protocols.
Collapse
|
26
|
Jones LAT, Bryden A, Wheeler TL, Tansey KE, Anderson KD, Beattie MS, Blight A, Curt A, Field-Fote E, Guest JD, Hseih J, Jakeman LB, Kalsi-Ryan S, Krisa L, Lammertse DP, Leiby B, Marino R, Schwab JM, Scivoletto G, Tulsky DS, Wirth E, Zariffa J, Kleitman N, Mulcahey MJ, Steeves JD. Considerations and recommendations for selection and utilization of upper extremity clinical outcome assessments in human spinal cord injury trials. Spinal Cord 2017; 56:414-425. [PMID: 29284795 PMCID: PMC5951792 DOI: 10.1038/s41393-017-0015-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/16/2017] [Accepted: 08/18/2017] [Indexed: 11/21/2022]
Abstract
Study design This is a focused review article. Objectives This review presents important features of clinical outcomes assessments (COAs) in human spinal cord injury research. Considerations for COAs by trial phase and International Classification of Functioning, Disability and Health are presented as well as strengths and recommendations for upper extremity COAs for research. Clinical trial tools and designs to address recruitment challenges are identified. Methods The methods include a summary of topics discussed during a two-day workshop, conceptual discussion of upper extremity COAs and additional focused literature review. Results COAs must be appropriate to trial phase and particularly in mid-late-phase trials, should reflect recovery vs. compensation, as well as being clinically meaningful. The impact and extent of upper vs. lower motoneuron disease should be considered, as this may affect how an individual may respond to a given therapeutic. For trials with broad inclusion criteria, the content of COAs should cover all severities and levels of SCI. Specific measures to assess upper extremity function as well as more comprehensive COAs are under development. In addition to appropriate use of COAs, methods to increase recruitment, such as adaptive trial designs and prognostic modeling to prospectively stratify heterogeneous populations into appropriate cohorts should be considered. Conclusions With an increasing number of clinical trials focusing on improving upper extremity function, it is essential to consider a range of factors when choosing a COA. Sponsors Craig H. Neilsen Foundation, Spinal Cord Outcomes Partnership Endeavor.
Collapse
Affiliation(s)
| | - Anne Bryden
- Case Western Reserve University, Cleveland, OH, USA
| | | | - Keith E Tansey
- University of Mississippi Medical Center, Jackson, MS, USA.,Methodist Rehabilitation Center, Jackson, MS, USA.,Veterans Administration Medical Center, Jackson, MS, USA
| | | | | | | | - Armin Curt
- University Hospital Balgrist, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Edelle Field-Fote
- Shepherd Center, Atlanta, GA, USA.,Emory University, Atlanta, GA, USA.,Georgia Institute of Technology, Atlanta, GA, USA
| | | | - Jane Hseih
- Wings for Life, Salzburg, Austria.,Parkwood Institute, London, ON, Canada
| | - Lyn B Jakeman
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Sukhvinder Kalsi-Ryan
- Toronto Rehabilitation Institute, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Laura Krisa
- Thomas Jefferson University, Philadelphia, PA, USA
| | - Daniel P Lammertse
- Craig Hospital, Englewood, CO, USA.,University of Colorado, Aurora, CO, USA
| | | | - Ralph Marino
- Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | | | - Ed Wirth
- Asterias Biotherapeutics, Fremont, CA, USA
| | - José Zariffa
- Toronto Rehabilitation Institute, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | | | | | | |
Collapse
|
27
|
Carrasco-López C, Jimenez S, Mosqueda-Pozon MC, Pérez-Borrego YA, Alcobendas-Maestro M, Gallego-Izquierdo T, Esclarin-Ruz A, Oliviero A. New Insights from Clinical Assessment of Upper Extremities in Cervical Traumatic Spinal Cord Injury. J Neurotrauma 2016; 33:1724-7. [PMID: 26936413 DOI: 10.1089/neu.2015.4155] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Upper extremity function has a strong impact on the quality of life in cervical spinal cord-injured patients. Upper extremity function depends on many factors, such as muscle strength, level of lesion, and extension of the cord damage in its axial axis produced by the injury. These variables can be obtained by the International Standards for Neurological Classification of Spinal Cord Injury, which is the standard for the functional evaluation of traumatic spinal cord injury (SCI) patients. The aim of this study was to describe the relationship between upper limb muscle strength, level of injury, and axial damage with the functionality of upper limb measured using the Jebsen-Taylor Hand Function Test (JTHFT) and the 9 Hole Peg Test (9HPT) in cervical SCI. Twenty-nine patients were included in this study. Our results suggest that both the JTHFT and 9HPT can be similarly used to quantify functional impairment after cervical SCI. Moreover, our data suggest that the upper extremity motor score, JTHFT, and 9HPT strongly correlate with the American Spinal Injury Association (ASIA) impairment scale (graded from A to E), but not with the lesion level. Our findings can be of great importance for the clinician or researchers whose therapeutic interventions have as a main objective to improve upper limb functionality in patients with cervical SCI. We suggest that ASIA impairment scale, ASIA motor score, and functional tests (including JTHFT and/or 9HPT) could be used as outcome measures in cervical SCI clinical trials.
Collapse
Affiliation(s)
| | - Samuel Jimenez
- 1 FENNSI Group, Hospital Nacional de Parapléjicos , SESCAM, Toledo, Spain .,2 Physiotherapy Department, Universidad Autónoma de Madrid , Madrid, Spain .,3 Physiotherapy Department, Alcalá de Henares University , Alcalá de Henares, Spain
| | | | | | | | | | - Ana Esclarin-Ruz
- 4 Rehabilitation Department, Hospital Nacional de Parapléjicos , SESCAM, Toledo, Spain
| | - Antonio Oliviero
- 1 FENNSI Group, Hospital Nacional de Parapléjicos , SESCAM, Toledo, Spain
| |
Collapse
|
28
|
Sinnott KA, Dunn JA, Wangdell J, Johanson ME, Hall AS, Post MW. Measurement of Outcomes of Upper Limb Reconstructive Surgery for Tetraplegia. Arch Phys Med Rehabil 2016; 97:S169-81. [DOI: 10.1016/j.apmr.2015.10.110] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 09/18/2015] [Accepted: 10/20/2015] [Indexed: 10/21/2022]
|
29
|
Pavese C, Schneider MP, Schubert M, Curt A, Scivoletto G, Finazzi-Agrò E, Mehnert U, Maier D, Abel R, Röhrich F, Weidner N, Rupp R, Kessels AG, Bachmann LM, Kessler TM. Prediction of Bladder Outcomes after Traumatic Spinal Cord Injury: A Longitudinal Cohort Study. PLoS Med 2016; 13:e1002041. [PMID: 27327967 PMCID: PMC4915662 DOI: 10.1371/journal.pmed.1002041] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 04/26/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Neurogenic bladder dysfunction represents one of the most common and devastating sequelae of traumatic spinal cord injury (SCI). As early prediction of bladder outcomes is essential to counsel patients and to plan neurourological management, we aimed to develop and validate a model to predict urinary continence and complete bladder emptying 1 y after traumatic SCI. METHODS AND FINDINGS Using multivariate logistic regression analysis from the data of 1,250 patients with traumatic SCI included in the European Multicenter Spinal Cord Injury study, we developed two prediction models of urinary continence and complete bladder emptying 1 y after traumatic SCI and performed an external validation in 111 patients. As predictors, we evaluated age, gender, and all variables of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and of the Spinal Cord Independence Measure (SCIM). Urinary continence and complete bladder emptying 1 y after SCI were assessed through item 6 of SCIM. The full model relies on lower extremity motor score (LEMS), light-touch sensation in the S3 dermatome of ISNCSI, and SCIM subscale respiration and sphincter management: the area under the receiver operating characteristics curve (aROC) was 0.936 (95% confidence interval [CI]: 0.922-0.951). The simplified model is based on LEMS only: the aROC was 0.912 (95% CI: 0.895-0.930). External validation of the full and simplified models confirmed the excellent predictive power: the aROCs were 0.965 (95% CI: 0.934-0.996) and 0.972 (95% CI 0.943-0.999), respectively. This study is limited by the substantial number of patients with a missing 1-y outcome and by differences between derivation and validation cohort. CONCLUSIONS Our study provides two simple and reliable models to predict urinary continence and complete bladder emptying 1 y after traumatic SCI. Early prediction of bladder function might optimize counselling and patient-tailored rehabilitative interventions and improve patient stratification in future clinical trials.
Collapse
Affiliation(s)
- Chiara Pavese
- Neurology, Spinal Cord Injury Center, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
- Specialization School in Physical Medicine and Rehabilitation, Department of Clinical-Surgical Sciences, University of Pavia, Rehabilitation Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marc P. Schneider
- Neuro-Urology, Spinal Cord Injury Center, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
- Brain Research Institute, University of Zürich, Zürich, Switzerland
| | - Martin Schubert
- Neurology, Spinal Cord Injury Center, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Armin Curt
- Neurology, Spinal Cord Injury Center, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | | | - Enrico Finazzi-Agrò
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Unit for Functional Urology, Department of Urology, Policlinico Tor Vergata, Rome, Italy
| | - Ulrich Mehnert
- Neuro-Urology, Spinal Cord Injury Center, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Doris Maier
- Spinal Cord Injury Center, BG-Trauma Center, Murnau, Germany
| | - Rainer Abel
- Spinal Cord Injury Center, Hohe Warte, Bayreuth, Germany
| | - Frank Röhrich
- Berufsgenossenschaftliche Kliniken Bergmannstrost, Zentrum für Rückenmarkverletzte und Klinik für Orthopädie, Halle, Germany
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Rüdiger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Alfons G. Kessels
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Thomas M. Kessler
- Neuro-Urology, Spinal Cord Injury Center, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
- * E-mail:
| |
Collapse
|
30
|
Tracking trauma-induced structural and functional changes above the level of spinal cord injury. Curr Opin Neurol 2015; 28:365-72. [DOI: 10.1097/wco.0000000000000224] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
31
|
Velstra IM, Bolliger M, Krebs J, Rietman JS, Curt A. Predictive Value of Upper Limb Muscles and Grasp Patterns on Functional Outcome in Cervical Spinal Cord Injury. Neurorehabil Neural Repair 2015; 30:295-306. [DOI: 10.1177/1545968315593806] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective. To determine which single or combined upper limb muscles as defined by the International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI); upper extremity motor score (UEMS) and the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP), best predict upper limb function and independence in activities of daily living (ADLs) and to assess the predictive value of qualitative grasp movements (QlG) on upper limb function in individuals with acute tetraplegia. Method. As part of a Europe-wide, prospective, longitudinal, multicenter study ISNCSCI, GRASSP, and Spinal Cord Independence Measure (SCIM III) scores were recorded at 1 and 6 months after SCI. For prediction of upper limb function and ADLs, a logistic regression model and unbiased recursive partitioning conditional inference tree (URP-CTREE) were used. Results. Logistic regression and URP-CTREE revealed that a combination of ISNCSCI and GRASSP muscles (to a maximum of 4) demonstrated the best prediction (specificity and sensitivity ranged from 81.8% to 96.0%) of upper limb function and identified homogenous outcome cohorts at 6 months. The URP-CTREE model with the QlG predictors for upper limb function showed similar results. Conclusion. Prediction of upper limb function can be achieved through a combination of defined, specific upper limb muscles assessed in the ISNCSCI and GRASSP. A combination of a limited number of proximal and distal muscles along with an assessment of grasping movements can be applied for clinical decision making for rehabilitation interventions and clinical trials.
Collapse
Affiliation(s)
| | - Marc Bolliger
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- European Multicenter Study about Human Spinal Cord Injury (EMSCI), Zurich, Switzerland
| | - Jörg Krebs
- Clinical Trial Unit, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Johan S. Rietman
- Roessingh Research and Development, Lab of Biomechanical Engineering, University of Twente, Enschede, Netherlands
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- European Multicenter Study about Human Spinal Cord Injury (EMSCI), Zurich, Switzerland
| |
Collapse
|
32
|
Krebs J, Katrin Brust A, Tesini S, Guler M, Mueller G, Velstra IM, Frotzler A. Study participation rate of patients with acute spinal cord injury early during rehabilitation. Spinal Cord 2015; 53:738-42. [DOI: 10.1038/sc.2015.73] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 03/02/2015] [Accepted: 04/01/2015] [Indexed: 11/09/2022]
|
33
|
Tanadini LG, Hothorn T, Jones LAT, Lammertse DP, Abel R, Maier D, Rupp R, Weidner N, Curt A, Steeves JD. Toward Inclusive Trial Protocols in Heterogeneous Neurological Disorders. Neurorehabil Neural Repair 2015; 29:867-77. [DOI: 10.1177/1545968315570322] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Several novel drug- and cell-based potential therapies for spinal cord injury (SCI) have either been applied or will be considered for future clinical trials. Limitations on the number of eligible patients require trials be undertaken in a highly efficient and effective manner. However, this is particularly challenging when people living with incomplete SCI (iSCI) represent a very heterogeneous population in terms of recovery patterns and can improve spontaneously over the first year after injury. Objective. The current study addresses 2 requirements for designing SCI trials: first, enrollment of as many eligible participants as possible; second, refined stratification of participants into homogeneous cohorts from a heterogeneous iSCI population. Methods. This is a retrospective, longitudinal analysis of prospectively collected SCI data from the European Multicenter study about Spinal Cord Injury (EMSCI). We applied conditional inference trees to provide a prediction-based stratification algorithm that could be used to generate decision rules for the appropriate inclusion of iSCI participants to a trial. Results. Based on baseline clinical assessments and a defined subsequent clinical endpoint, conditional inference trees partitioned iSCI participants into more homogeneous groups with regard to the illustrative endpoint, upper extremity motor score. Assuming a continuous endpoint, the conditional inference tree was validated both internally as well as externally, providing stable and generalizable results. Conclusion. The application of conditional inference trees is feasible for iSCI participants and provides easily implementable, prediction-based decision rules for inclusion and stratification. This algorithm could be utilized to model various trial endpoints and outcome thresholds.
Collapse
Affiliation(s)
- Lorenzo G. Tanadini
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Torsten Hothorn
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | | | - Daniel P. Lammertse
- Craig Hospital, Englewood, CO, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado Denver, Aurora, CO, USA
| | - Rainer Abel
- Trauma Center Bayreuth, Bayreuth, Germany
- EMSCI Study Group
| | - Doris Maier
- EMSCI Study Group
- Trauma Center Murnau, Murnau, Germany
| | - Rüdiger Rupp
- EMSCI Study Group
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Norbert Weidner
- EMSCI Study Group
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- EMSCI Study Group
| | - John D. Steeves
- ICORD, University of British Columbia and Vancouver Coastal Health, Vancouver, Canada
| |
Collapse
|
34
|
Velstra IM, Curt A, Frotzler A, Abel R, Kalsi-Ryan S, Rietman JS, Bolliger M. Changes in Strength, Sensation, and Prehension in Acute Cervical Spinal Cord Injury. Neurorehabil Neural Repair 2015; 29:755-66. [DOI: 10.1177/1545968314565466] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective. To investigate the internal and external responsiveness and recovery profiles of the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP) instrument in revealing changes in upper limb function within the first year following cervical spinal cord injury (SCI). Method. A European prospective, longitudinal, multicenter study assessing the GRASSP at 1, 3, 6, and 12 months after cervical SCI. Subtests of GRASSP were compared to the upper extremity motor (UEMS) and light touch scores (LT) according to the International Standards of Neurological Classification of Spinal Cord Injury (ISNCSCI), the Spinal Cord Independence Measure self-care subscore (SCIM-SS), as well as a clinician-rated outcome measure (CROM) of clinical relevance. Data were analyzed for GRASSP responsiveness and recovery rate over time. Results. Seventy-four participants entered the study. GRASSP subtests proved responsive (standardized response mean [SRM] ranged from 0.79 to 1.48 for strength, 0.50 to 1.03 for prehension, and 0.14 to 0.64 for sensation) between all examination time points. In comparison, UEMS and LT showed lower responsiveness (SRM UEMS ranged from 0.69 to 1.29 and SRM LT ranged from 0.30 to −0.13). All GRASSP subtests revealed significant, moderate-to-excellent correlations with UEMS, LT, and SCIM-SS at each time point, and changes in GRASSP subtests were in accordance with the CROM. GRASSP prehension and motor recovery was largest between 1 and 3 months. Conclusion. The GRASSP showed excellent responsiveness, detecting distinct changes in strength and prehension relating to the severity of cervical SCI. It detected clinically significant changes complimentary to the ISNCSCI and SCIM-SS assessments.
Collapse
Affiliation(s)
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- European Multicenter Study about Human Spinal Cord Injury (EMSCI)
| | - Angela Frotzler
- Clinical Trial Unit, Swiss Paraplegic Center, Nottwil, Switzerland
| | - Rainer Abel
- Spinal Cord Injury Center, Hohe Warte, Bayreuth, Germany
| | - Sukhvinder Kalsi-Ryan
- Krembil Neuroscience Program, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Johan S. Rietman
- Roessingh Research and Development, Lab of Biomechanical Engineering, University of Twente, Enschede, Netherlands
| | - Marc Bolliger
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- European Multicenter Study about Human Spinal Cord Injury (EMSCI)
| |
Collapse
|
35
|
Nielson JL, Haefeli J, Salegio EA, Liu AW, Guandique CF, Stück ED, Hawbecker S, Moseanko R, Strand SC, Zdunowski S, Brock JH, Roy RR, Rosenzweig ES, Nout-Lomas YS, Courtine G, Havton LA, Steward O, Reggie Edgerton V, Tuszynski MH, Beattie MS, Bresnahan JC, Ferguson AR. Leveraging biomedical informatics for assessing plasticity and repair in primate spinal cord injury. Brain Res 2014; 1619:124-38. [PMID: 25451131 DOI: 10.1016/j.brainres.2014.10.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 10/22/2014] [Accepted: 10/23/2014] [Indexed: 11/18/2022]
Abstract
Recent preclinical advances highlight the therapeutic potential of treatments aimed at boosting regeneration and plasticity of spinal circuitry damaged by spinal cord injury (SCI). With several promising candidates being considered for translation into clinical trials, the SCI community has called for a non-human primate model as a crucial validation step to test efficacy and validity of these therapies prior to human testing. The present paper reviews the previous and ongoing efforts of the California Spinal Cord Consortium (CSCC), a multidisciplinary team of experts from 5 University of California medical and research centers, to develop this crucial translational SCI model. We focus on the growing volumes of high resolution data collected by the CSCC, and our efforts to develop a biomedical informatics framework aimed at leveraging multidimensional data to monitor plasticity and repair targeting recovery of hand and arm function. Although the main focus of many researchers is the restoration of voluntary motor control, we also describe our ongoing efforts to add assessments of sensory function, including pain, vital signs during surgery, and recovery of bladder and bowel function. By pooling our multidimensional data resources and building a unified database infrastructure for this clinically relevant translational model of SCI, we are now in a unique position to test promising therapeutic strategies' efficacy on the entire syndrome of SCI. We review analyses highlighting the intersection between motor, sensory, autonomic and pathological contributions to the overall restoration of function. This article is part of a Special Issue entitled SI: Spinal cord injury.
Collapse
Affiliation(s)
- Jessica L Nielson
- Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco, CA (UCSF), United States
| | - Jenny Haefeli
- Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco, CA (UCSF), United States
| | - Ernesto A Salegio
- Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco, CA (UCSF), United States
| | - Aiwen W Liu
- Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco, CA (UCSF), United States
| | - Cristian F Guandique
- Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco, CA (UCSF), United States
| | - Ellen D Stück
- Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco, CA (UCSF), United States
| | - Stephanie Hawbecker
- California National Primate Research Center (CNPRC), University of California, Davis, CA (UCD), United States
| | - Rod Moseanko
- California National Primate Research Center (CNPRC), University of California, Davis, CA (UCD), United States
| | - Sarah C Strand
- California National Primate Research Center (CNPRC), University of California, Davis, CA (UCD), United States
| | - Sharon Zdunowski
- Department of Integrative Biology and Physiology, University of California, Los Angeles, CA (UCLA), United States
| | - John H Brock
- Center for Neural Repair, Department of Neurosciences, University of California, San Diego, La Jolla, CA (UCSD), United States
| | - Roland R Roy
- Department of Integrative Biology and Physiology, University of California, Los Angeles, CA (UCLA), United States
| | - Ephron S Rosenzweig
- Center for Neural Repair, Department of Neurosciences, University of California, San Diego, La Jolla, CA (UCSD), United States
| | - Yvette S Nout-Lomas
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, United States
| | - Gregoire Courtine
- Center for Neuroprosthetics and Brain Mind Institute, Swiss Federal Institute of Technology (EPFL), United States
| | - Leif A Havton
- Reeve-Irvine Research Center (RIRC), University of California, Irvine, CA (UCI), United States; Departments of Anesthesiology & Perioperative Care, Neurology, and Anatomy & Neurobiology, University of California, Irvine, CA, United States
| | - Oswald Steward
- Reeve-Irvine Research Center (RIRC), University of California, Irvine, CA (UCI), United States; Departments of Anatomy & Neurobiology, Neurobiology & Behavior, and Neurosurgery, University of California, Irvine, CA, United States
| | - V Reggie Edgerton
- Department of Integrative Biology and Physiology, University of California, Los Angeles, CA (UCLA), United States
| | - Mark H Tuszynski
- Departments of Anesthesiology & Perioperative Care, Neurology, and Anatomy & Neurobiology, University of California, Irvine, CA, United States; Veterans Administration Medical Center, La Jolla, CA, United States
| | - Michael S Beattie
- Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco, CA (UCSF), United States
| | - Jacqueline C Bresnahan
- Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco, CA (UCSF), United States
| | - Adam R Ferguson
- Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco, CA (UCSF), United States.
| |
Collapse
|
36
|
Kalsi-Ryan S, Beaton D, Curt A, Popovic MR, Verrier MC, Fehlings MG. Outcome of the upper limb in cervical spinal cord injury: Profiles of recovery and insights for clinical studies. J Spinal Cord Med 2014; 37:503-10. [PMID: 25229734 PMCID: PMC4166185 DOI: 10.1179/2045772314y.0000000252] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Improved appreciation of recovery profiles of sensory and motor function as well as complex motor functions (prehension) after cervical spinal cord injury (SCI) will be essential to inform clinical studies to consider primary and secondary outcome measures for interventions and the optimization of dosing and timing of therapies in acute and chronic SCI. OBJECTIVES (1) To define the sensory, motor, and prehension recovery profiles of the upper limb and hand in acute cervical SCI and (2) to confirm the impact of AIS severity and conversion on upper limb sensorimotor recovery. METHODS An observational longitudinal cohort study consisting of serial testing of 53 patients with acute cervical SCI was conducted. International Standards of Neurological Classification of Spinal Cord Injury, Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP), Capabilities of Upper Extremity (CUE-Q) Questionnaire, and Spinal Cord Independence Measure III (SCIM-III) were administered at 0-10 days, 1, 3, 6, and 12 months. ANALYSIS Change over time was plotted using mean and standard deviation of the total and subgroups of the sample. RESULTS Individuals with traumatic tetraplegia show distinct patterns of recovery. Factors that distinguish homogeneous subgroups of the sample are: severity of injury (level of injury, completeness) at baseline and conversion from a complete to an incomplete injury. CONCLUSIONS In cervical SCI, clinical recovery can be assessed using standardized measures that distinguish levels of activity and impairment. Specific recovery profiles of the upper limb over the 1-year timecourse provide new insights and opportunity for combined analysis of recovery profiles for different clinical assessment tools of upper limb function which are meaningful to inform the design of study protocols.
Collapse
Affiliation(s)
- Sukhvinder Kalsi-Ryan
- Spinal Program, Krembil Neuroscience Centre, University Health Network, University of Toronto, ON, Canada,Correspondence to: Sukhvinder Kalsi-Ryan, Spinal Program, Krembil Neuroscience Centre, University Health Network, University of Toronto, ON, Canada M5T 2S8.
| | | | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | | | - Mary C. Verrier
- Lyndhurst Centre SCI Mobility Lab, Toronto Rehabilitation Institute, Toronto, ON, Canada
| | | |
Collapse
|