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Walden K, Bélanger LM, Biering-Sørensen F, Burns SP, Echeverria E, Kirshblum S, Marino RJ, Noonan VK, Park SE, Reeves RK, Waring W, Dvorak MF. Development and validation of a computerized algorithm for International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). Spinal Cord 2015; 54:197-203. [PMID: 26323348 PMCID: PMC5399136 DOI: 10.1038/sc.2015.137] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/28/2015] [Accepted: 06/24/2015] [Indexed: 12/21/2022]
Abstract
STUDY DESIGN Validation study. OBJECTIVES To describe the development and validation of a computerized application of the international standards for neurological classification of spinal cord injury (ISNCSCI). SETTING Data from acute and rehabilitation care. METHODS The Rick Hansen Institute-ISNCSCI Algorithm (RHI-ISNCSCI Algorithm) was developed based on the 2011 version of the ISNCSCI and the 2013 version of the worksheet. International experts developed the design and logic with a focus on usability and features to standardize the correct classification of challenging cases. A five-phased process was used to develop and validate the algorithm. Discrepancies between the clinician-derived and algorithm-calculated results were reconciled. RESULTS Phase one of the validation used 48 cases to develop the logic. Phase three used these and 15 additional cases for further logic development to classify cases with 'Not testable' values. For logic testing in phases two and four, 351 and 1998 cases from the Rick Hansen SCI Registry (RHSCIR), respectively, were used. Of 23 and 286 discrepant cases identified in phases two and four, 2 and 6 cases resulted in changes to the algorithm. Cross-validation of the algorithm in phase five using 108 new RHSCIR cases did not identify the need for any further changes, as all discrepancies were due to clinician errors. The web-based application and the algorithm code are freely available at www.isncscialgorithm.com. CONCLUSION The RHI-ISNCSCI Algorithm provides a standardized method to accurately derive the level and severity of SCI from the raw data of the ISNCSCI examination. The web interface assists in maximizing usability while minimizing the impact of human error in classifying SCI. SPONSORSHIP This study is sponsored by the Rick Hansen Institute and supported by funding from Health Canada and Western Economic Diversification Canada.
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Affiliation(s)
- K Walden
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - L M Bélanger
- Rick Hansen Institute, Vancouver, British Columbia, Canada.,Vancouver Spine Program, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - F Biering-Sørensen
- Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Havnevej, Hornbaek, Denmark
| | - S P Burns
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - E Echeverria
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - S Kirshblum
- Kessler Institute for Rehabilitation, Rutgers New Jersey Medical School, West Orange, NJ, USA
| | - R J Marino
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - V K Noonan
- Rick Hansen Institute, Vancouver, British Columbia, Canada.,Department of Orthopedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - S E Park
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - R K Reeves
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - W Waring
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, USA
| | - M F Dvorak
- Vancouver Spine Program, Vancouver General Hospital, Vancouver, British Columbia, Canada.,Department of Orthopedics, University of British Columbia, Vancouver, British Columbia, Canada
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Kirshblum SC, Biering-Sørensen F, Betz R, Burns S, Donovan W, Graves DE, Johansen M, Jones L, Mulcahey MJ, Rodriguez GM, Schmidt-Read M, Steeves JD, Tansey K, Waring W. International standards for neurological classification of spinal cord injury: cases with classification challenges. Top Spinal Cord Inj Rehabil 2014; 20:81-9. [PMID: 25477729 DOI: 10.1310/sci2002-81] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI) is routinely used to determine levels of injury and to classify the severity of the injury. Questions are often posed to the International Standards Committee of the American Spinal Injury Association (ASIA) regarding the classification. The committee felt that disseminating some of the challenging questions posed, as well as the responses, would be of benefit for professionals utilizing the ISNCSCI. Case scenarios that were submitted to the committee are presented with the responses as well as the thought processes considered by the committee members. The importance of this documentation is to clarify some points as well as update the SCI community regarding possible revisions that will be needed in the future based upon some rules that require clarification.
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Affiliation(s)
- S C Kirshblum
- Kessler Institute for Rehabilitation, West Orange, New Jersey, and Rutgers New Jersey Medical School , Newark, New Jersey
| | - F Biering-Sørensen
- Clinic for Spinal Cord Injuries, Glostrup University Hospital, and Faculty of Health Sciences, University of Copenhagen , Denmark
| | - R Betz
- Shriners Hospitals for Children-Philadelphia , Philadelphia, Pennsylvania
| | - S Burns
- University of Washington School of Medicine , Seattle, Washington
| | - W Donovan
- The Institute for Rehabilitation & Research , Houston, Texas
| | - D E Graves
- University of Louisville , Louisville, Kentucky
| | | | - L Jones
- Craig H. Neilsen Foundation , Encino, California
| | - M J Mulcahey
- Jefferson School of Health Professions, Thomas Jefferson University , Philadelphia, Pennsylvania
| | - G M Rodriguez
- University of Michigan Hospital and Health Systems , Ann Arbor, Michigan
| | - M Schmidt-Read
- Magee Rehabilitation Hospital , Philadelphia, Pennsylvania
| | - J D Steeves
- International Collaboration On Repair Discoveries, University of British Columbia , Vancouver, British Columbia, Canada
| | - K Tansey
- Departments of Neurology and Physiology, Emory University School of Medicine, and Veterans Administration Medical Center , Atlanta, Georgia
| | - W Waring
- Medical College of Wisconsin , Milwaukee, Wisconsin
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Kirshblum SC, Biering-Sorensen F, Betz R, Burns S, Donovan W, Graves DE, Johansen M, Jones L, Mulcahey MJ, Rodriguez GM, Schmidt-Read M, Steeves JD, Tansey K, Waring W. International Standards for Neurological Classification of Spinal Cord Injury: cases with classification challenges. J Spinal Cord Med 2014; 37:120-7. [PMID: 24559416 PMCID: PMC4066420 DOI: 10.1179/2045772314y.0000000196] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI) is routinely used to determine the levels of injury and to classify the severity of the injury. Questions are often posed to the International Standards Committee of the American Spinal Injury Association regarding the classification. The committee felt that disseminating some of the challenging questions posed, as well as the responses, would be of benefit for professionals utilizing the ISNCSCI. Case scenarios that were submitted to the committee are presented with the responses as well as the thought processes considered by the committee members. The importance of this documentation is to clarify some points as well as update the SCI community regarding possible revisions that will be needed in the future based upon some rules that require clarification.
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Affiliation(s)
- S. C. Kirshblum
- Kessler Institute for Rehabilitation, Rutgers/New Jersey Medical School, West orange, NJ, USA,Correspondence to: S. C. Kirshblum, Kessler Institute for Rehabilitation, Rutgers/New Jersey Medical School, West Orange, NJ 07052, USA.
| | - F. Biering-Sorensen
- Clinic for Spinal Cord Injuries, Glostrup University Hospital and Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - R. Betz
- Shriners Hospitals for Children – Philadelphia, Philadelphia, PA, USA
| | - S. Burns
- University of Washington School of Medicine, Seattle, WA, USA
| | - W. Donovan
- The Institute for Rehabilitation and Research, Houston, TX, USA
| | | | | | - L. Jones
- Linda Jones PT, MS. Craig H. Neilsen Foundation, Encino, CA, USA
| | - M. J. Mulcahey
- Jefferson School of Health Professions, Thomas Jefferson University, Philadelphia, PA, USA
| | - G. M. Rodriguez
- University of Michigan Hospital and Health Systems, Ann Arbor, MI, USA
| | | | - J. D. Steeves
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
| | - K. Tansey
- Departments of Neurology and Physiology, Emory University School of Medicine, Veterans Administration Medical Center, Atlanta, GA, USA
| | - W. Waring
- Medical College of Wisconsin, Milwaukee, WI, USA
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Abstract
There is little in the literature regarding bowel management in children and adolescents with spinal cord injuries (SCI). This study was undertaken to examine specific patterns of bowel care, individual levels of satisfaction with bowel management, the incidence of incontinence in this population, and effects on lifestyle because of time commitment and dependence in bowel management. Surveys were sent to all persons (n = 45) under age 19 with a diagnosis of SCI who had received care at our medical center since 1985. Thirty-one subjects (69 percent) returned the surveys. The average age at injury was 8.1 years, with an average follow-up period of 3.9 years. Fifty-five percent were individuals with tetraplegia and 77 percent had a complete injury (ASIA Class A). A bowel management program, including medications or manual manipulation, was required for 81 percent of the subjects; only two were independent in their bowel management. Over half of the subjects performed evening bowel care and over half performed their care daily. Digital stimulation tended to be used more commonly by younger children. Medications, either oral, rectal, or both, were used by 88 percent. Sixty percent of the subjects reported they were completely or very satisfied with their bowel management. About half the subjects had limited freedom because of their bowel programs, which caused some dissatisfaction. Sixty-eight percent reported occasional or frequent interference with school activities because of their bowel programs. No correlation was found between bowel accidents and satisfaction with bowel management, despite the fact that almost 84 percent of the children reported at least rare accidents. Lifestyle limitations, bowel accidents, dependence in bowel management, and subject and family dissatisfaction continue to be significant problems for children and adolescents with SCI.
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Affiliation(s)
- L L Goetz
- Veterans Administration North Texas Health Care System, Dallas 75216, USA
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Werner RA, Waring W, Maynard F. Osteoarthritis of the hand and wrist in the post poliomyelitis population. Arch Phys Med Rehabil 1992; 73:1069-72. [PMID: 1444774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
People with a chronic motor disability of the legs become increasingly more dependent upon their upper limbs for mobility and self-care skills as they age. Many of them complain of hand and wrist pain. A cross-sectional study of 61 post-poliomyelitis survivors was done to determine the prevalence of osteoarthritis within this population and to determine any inherent risk factors. Each subject underwent a radiographic evaluation of both hands and wrist as well as a detailed physical examination. A questionnaire was used to ascertain a history of hand activity, use of canes/crutches, walkers and wheelchairs. The mean age of the population sample was 49 +/- 6 with a mean duration of disability of 35 +/- 4 years. The prevalence of moderate or severe osteoarthritis of either the hand or wrist was 13% whereas the prevalence was 68% when cases with mild arthritic changes were also included. The risk factors associated with hand and wrist osteoarthritis in this population included age, lower limb weakness, use of an assistive devices, and severity of disability.
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Affiliation(s)
- R A Werner
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical Center, Ann Arbor 48109-0042
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Abstract
Controversy exists with regard to the actual prevalence of compressive mononeuropathies at the wrist which may occur following chronic paraplegia. Thirty one chronic paraplegics, with a mean age of 37.9 years (range 20-68 years), and mean time since injury of 9.7 years (range 1-28 years), were studied with a comprehensive neurologic and electrodiagnostic (EDX) assessment. No patient had any clinical or EDX evidence of a peripheral polyneuropathy. The diagnosis of a median mononeuropathy at the wrist was determined by the following criteria: (a) prolonged median sensory distal latency greater than ipsilateral ulnar sensory distal latency greater than or equal to 0.5 msec; (b) a median mid-palmar sensory latency greater than ipsilateral ulnar mid-palmar sensory latency of greater than or equal to 0.3 msec; or (c) a median motor distal latency greater than or equal to 1.7 milliseconds as compared to the ipsilateral ulnar motor distal latency. Ulnar mononeuropathy at the wrist or across the elbow was also characterised. The EDX criteria for a median mononeuropathy at the wrist was met in 55% of subjects (24% of these with bilateral presentations). The location of ulnar mononeuropathies included: two at the superficial sensory branch at the wrist, one at the deep motor branch at the wrist, and three patients with a conduction block across the elbow. Overall, 67% of all patients tested had evidence of at least one mononeuropathy of the upper extremity. There was no association between prevalence of compressive mononeuropathies and age of the patient or time since onset of injury.
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Affiliation(s)
- G Davidoff
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical Center, Ann Arbor
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Abstract
There is evidence that chronic cane, crutch, and wheelchair users are at increased risk for developing pain and functional compromise of the wrist and hand. This investigation examined the prevalence and risk factors for median mononeuropathy at the wrist in the postpoliomyelitis population. The medical records of 148 consecutive patients with histories of poliomyelitis were reviewed. Forty-nine percent of this cohort had complaints of wrist pain. The prevalence rate of carpal tunnel syndrome was 22% (n = 33). Age, sex, duration of disability, and work history did not significantly influence the relative risk of developing this disorder. However, the relative risk of developing this compression neuropathy at the wrist by using the combination of a cane and/or a crutch and a wheelchair was 4.86 (95% confidence interval 2.35-10.06). The high risk associated with chronic cane, crutch, and wheelchair use shows the need for developing preventive strategies.
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Affiliation(s)
- R Werner
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical Center, Ann Arbor
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McCarty JM, Tilden SJ, Black P, Craft JC, Blumer J, Waring W, Halsey NA. Comparison of piperacillin alone versus piperacillin plus tobramycin for treatment of respiratory infections in children with cystic fibrosis. Pediatr Pulmonol 1988; 4:201-4. [PMID: 3393383 DOI: 10.1002/ppul.1950040403] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Seventeen patients with cystic fibrosis (CF) and pulmonary exacerbations were randomly assigned to two treatment groups: piperacillin 600 mg/kg/day (P), and piperacillin 600 mg/kg/day plus tobramycin (PT), in order to determine the safety and pharmacokinetics of high-dose piperacillin and whether piperacillin alone was effective for the treatment of Pseudomonas infections. The mean half-life of piperacillin was 0.54 hours, with a peak concentration of 232 micrograms/ml. No differences between P and PT groups were noted in clinical assessment, as judged by Shwachman scores, pulmonary function testing, or weight gain. However, during the course of treatment, quantitative sputum cultures decreased by greater than 10(2) colony-forming units in only 5 out of 19 Pseudomonas isolates from the P group, compared with 12 of 19 isolates from the PT group (P less than 0.03, Chi-square). Although emergence of resistance was not seen, one isolate had an increase in minimum inhibitory concentration from 8 to 128 micrograms/ml. There were no serious adverse reactions to piperacillin; only one patient developed fever possibly related to piperacillin. Therapy with high-dose piperacillin was safe in children with CF. Treatment with piperacillin alone was less effective than combination therapy with gentamicin for reduction in titer of Pseudomonas in sputum. However, the role of antimicrobial agents in the treatment of CF remains undefined. A double-blind placebo-controlled trial is indicated.
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Affiliation(s)
- J M McCarty
- Department of Pediatrics, Tulane University, New Orleans, Louisiana
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Harper TB, Gaumer HR, Waring W, Brannon RB, Salvaggio JE. A comparison of cell-mediated immunity and suppressor T-cell function in asthmatic and normal children. Clin Allergy 1980; 10:555-63. [PMID: 6449316 DOI: 10.1111/j.1365-2222.1980.tb02137.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The role of general and suppressor T-cell function was investigated in a group of twelve children with atopic asthma and ten non-atopic control children. Studies of active E rosettes, lymphocyte stimulation, and delayed type skin responsiveness revealed no statistically significant group differences. Data obtained employing a concanavalin A-induced, suppressor T-cell assay revealed that the asthmatics generated significantly less suppressor cell activity than did the normal control group. There was no correlation between lack of suppressor cell function and serum IgE levels. The results of this study support the concept of suppressor T-cell dysfunction in atopic disease.
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Harper TB, Gaumer HR, Waring W, Brannon RB, Salvaggio JE. Cell mediated immunity and suppressor T cell function in children with cystic fibrosis. Lung 1979; 157:219-28. [PMID: 6967542 DOI: 10.1007/bf02713621] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Owen EW, Waring W, Shoji FF, Prakash CV. Digital simulation of the membrane voltages and currents in nerve and muscle fibers. Comput Programs Biomed 1976; 6:63-73. [PMID: 954415 DOI: 10.1016/0010-468x(76)90027-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This paper describes digital computer simulations of the membrane voltages and currents in axons and muscle fibers. The simulations, which allow calculations ona nonuniform fiber, are based on the discrete Hodgkin-Huxley and Falk-Fatt equations. An efficient algorithm is used to solve the set of equations generated. Calculations are made of the voltage and current at the natural end of a muscle fiber and the results are compared with measurements by other investigators.
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Sly RM, Ghazanshahi S, Buranakul B, Puapan P, Gupta S, Warren R, Waring W. Objective assessment for digital clubbing in Caucasian, Negro, and Oriental subjects. Chest 1973; 64:687-9. [PMID: 4760016 DOI: 10.1378/chest.64.6.687] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Schramel R, Waring W, Lago D, Fortenberry R. Congenital lobar emphysema: report of a case treated by bilateral simultaneous pulmonary resection. J La State Med Soc 1968; 120:111-4. [PMID: 5648849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Waring W. Symposium on approaches to problems of human disability by biomedical engineering. Arch Phys Med Rehabil 1967; 48:339-40. [PMID: 4226219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Antonelli DJ, Waring W. Myoelectric control of powered devices. Arch Phys Med Rehabil 1967; 48:345-9. [PMID: 4226221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Abstract
(1) A common error in text-books on physical chemistry is pointed out. It is hoped that the correct value for the triple point temperature, +.0098 degrees C, will be given in new books and in succeeding editions of the books surveyed above. (2) Inconsistencies in the vapor pressure values for ice and for liquid water near 0 degrees C are pointed out. (3) The equilibrium vapor pressures for ice and liquid water under two different sets of equilibrium conditions are compared with the triple point pressure.
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