Using the Standing and Walking Assessment Tool at Discharge Predicts Community Outdoor Walking Capacity in Persons With Traumatic Spinal Cord Injury.

A concomitant traumatic brain injury is often seen in patients with acute traumatic spinal cord injury. Unfortunately, the exact epidemiology of concomitant traumatic brain injury-traumatic spinal cord injury remains unknown. Our objective was to determine the incidence of concomitant traumatic brain injury-traumatic spinal cord injury and identify clinical factors associated with its occurrence. A prospective cross-sectional study of 476 traumatic spinal cord injury patients was conducted. In all patients, baseline characteristics were routinely collected and the presence of a traumatic brain injury was sought prospectively by a specialized neurosurgeon using standardized diagnostic criteria based on clinical and radiological variables. Of the 476 included patients, 250 (53%) had isolated traumatic spinal cord injury and 226 (47%) had concomitant traumatic brain injury-traumatic spinal cord injury. Almost 85% of diagnosed traumatic brain injuries were mild. At the univariate level, patients with concomitant traumatic brain injury-traumatic spinal cord injury were more likely to present a history of drug/alcohol abuse ( P = 0.014), be involved in a motor vehicle accident ( P < 0.001), sustain a high energy mechanism ( P < 0.001), or present tetraplegia rather than paraplegia ( P = 0.021). These factors all remained significant at the multivariate level. A concomitant traumatic brain injury can be found in around 50% of traumatic spinal cord injury individuals. There are several clinical variables that should increase clinical suspicion of underlying traumatic brain injury and warrant further investigation to facilitate prompt identification and treatment of affected patients.

Background/Objectives: Community ambulation after stroke depends on locomotor capacity and confidence in everyday environments. We compared functional performance across three community walking levels and identified constructs independently associated with being an independent community walker in individuals with chronic stroke. Methods: Adults admitted to an acute-care general hospital or an inpatient rehabilitation hospital were enrolled. Community walking level was classified by a self-reported questionnaire. Primary constructs were gait speed, gait endurance, and balance self-efficacy measured with standard clinical tests. Additional measures described balance, lower-limb motor function, and task-based mobility. Group differences were examined with one-way analysis of variance with Bonferroni comparisons. Community walking status was modeled with binary logistic regression using forward stepwise selection. Results: Fifty-nine individuals were analyzed. Performance differed across levels. Effect sizes were small, medium, or large overall. Independent community walkers showed faster gait speed, longer walking distance, and higher balance self-efficacy, with the same direction for balance and lower-limb motor scores and shorter times on task-based tests. In univariable models, age, sex, and time since stroke were not associated with independence, whereas assistive device use related to lower odds. In the multivariable model, gait speed, gait endurance, and balance self-efficacy retained independent associations with independent community walking. Other measures were not retained after adjustment. Conclusions: Community walking status in chronic stroke relates most closely to gait speed, gait endurance, and balance self-efficacy. Evaluation can emphasize the 10 m Walk Test, 6 Min Walk Test, and Activities-specific Balance Confidence Scale, with impairment and task-based tests used to guide intervention planning.

Use of the Houghton Scale to Classify Community and Household Walking Ability in People With Lower-Limb Amputation: Criterion-Related Validity

Predicting falls within the elderly community: comparison of postural sway, reaction time, the Berg balance scale and the Activities-specific Balance Confidence (ABC) scale for comparing fallers and non-fallers

INTRODUCTION: Cervical spinal cord injury (SCI) results in devastating paralysis. Spinal column injury (i.e., traumatic SCI) may result in worse outcomes as compared to non-traumatic SCI. However, there remains a lack robust data determining the role of traumatic etiology in prognosticating outcomes after cervical SCI. METHODS: From prospective cohort of SCI model systems, we included adult patients &gt;15 years with traumatic SCI, neurological-level C1-C8, ASIA impairment-scale (AIS) A-D, presented within 30-days of SCI. Traumatic SCI was defined as SCI resulting from spinal column injury and non-traumatic SCI was defined as SCI without any spinal column injury. The primary outcome was composite independence in eating, bladder-management, and transfers domains of functional independence measure at 1-year. Each domain ranges from 1-7; lower score indicating greater functional dependence. Composite independence was defined as score of &gt;=6 in at least 2 domains. RESULTS: Between 1992-2016, 853 patients with cervical SCI and complete neurological/functional measures were included. At baseline, 86% (737) had traumatic SCI and 14% (116) had non-traumatic SCI. Patients with traumatic SCI had significantly larger rates of motor-complete SCI (AIS A-B); 71% versus 31% in non-traumatic SCI (p&lt;0.001). At one-year follow-up, non-traumatic SCI had significantly larger recovery rates in FIM functions compared to traumatic SCI; 53% of non-traumatic cervical SCI patients gained composite independence in FIM functions vs. 39% in traumatic cervical SCI (p=0.007). In multivariable regression, after accounting for age, sex, symmetry-of-SCI, and SCI severity by AIS grade, traumatic SCI was not a significant predictor of functional outcome (p=0.47). CONCLUSIONS: Although patients with traumatic SCI present with worse injury severity as compared to non-traumatic SCI. However, both traumatic and non-traumatic cervical SCI have a similar recovery potential. Optimization of clinical pathways is needed to provide appropriate rehabilitation care for patients with cervical SCI.

Context/Objective: The study objectives were to evaluate the test-retest reliability, convergent validity, and discriminative validity of the Activities-specific Balance Confidence (ABC) scale in individuals with incomplete spinal cord injury (iSCI). Design: Prospective, cross-sectional study. Setting: Laboratory. Participants: Twenty-six community-dwelling individuals with chronic iSCI (20 males, 59.7 + 18.9 years old) and 26 age- and sex-matched able-bodied (AB) individuals participated. Interventions: None. Outcome Measures: Measures of balance and gait were collected over two days. Clinical measures included the ABC scale, Mini-Balance Evaluation System’s Test, 10-meter Walk Test, SCI Functional Ambulation Profile, manual muscle testing of lower extremity muscles, and measures of lower extremity proprioception and cutaneous pressure sensitivity. Biomechanical measures included the velocity and sway area of centre of pressure (COP) movement during quiet standing. Results: The ABC scale demonstrated high test-retest reliability (intraclass correlation coefficient = 0.93) among participants with iSCI. The minimal detectable change was 14.87%. ABC scale scores correlated with performance on all clinical measures (ρ=0.60-0.80, P<0.01), with the exception of proprioception and cutaneous pressure sensitivity (P=0.20–0.70), demonstrating convergent validity. ABC scale scores also correlated with overall COP velocity (ρ=-0.69, P<0.001) and COP velocity in the anterior-posterior direction (ρ=-0.71, P<0.001). Participants with iSCI scored significantly lower on the ABC scale than the AB participants (P<0.001), and the area under the receiver operating characteristic curve was 0.95, demonstrating discriminative validity. Conclusion: The ABC scale is a reliable and valid measure of balance confidence in community-dwelling, ambulatory individuals with chronic iSCI.

ABSTRACTBackground/Purpose: Individuals with incomplete spinal cord injuries (ISCIs) commonly face persistent gait impairments. Backward walking training may be a useful rehabilitation approach, providing novel gait and balance challenges. However, little is known about the effects of this approach for individuals with ISCIs. The purpose of this case report was to describe the effects of backward walking training on strength, balance, and upright mobility in an individual with chronic ISCI. Methods: A 28-year-old female, 11-years post ISCI (C4, AIS D) completed 18-sessions of backward walking training on a treadmill with partial body-weight support and overground. Training emphasized stepping practice, speed, and kinematics. Outcome measures included: Lower Extremity Motor Score, Berg Balance Scale (BBS), Sensory Organization Test (SOT), 10-Meter Walk Test (10MWT), 3-meter backward walking test, Timed Up and Go (TUG), and Activities-Specific Balance Confidence (ABC) Scale. Results: Strength did not change. Improved balance was evident based on BBS (20 to 37/56) and SOT scores (27 to 40/100). Upright mobility improved based on TUG times (57 to 32.7 s), increased 10MWT speed (0.23 to 0.31 m/s), and backward gait speed (0.07 to 0.12 m/s). Additionally, self-reported balance confidence (ABC Scale) increased from 36.9% to 49.6%. Conclusions: The results suggest that backward walking may be a beneficial rehabilitation approach; examination of the clinical efficacy is warranted.

194. Expansile duraplasty improves motor outcomes after acute traumatic spinal cord injury

Distinguishing between a clinically significant change and change due to measurement error can be difficult. The purpose of this study was to determine test-retest reliability and minimal detectable change for the Berg Balance Scale (BBS), forward and backward functional reach, the Romberg Test and the Sharpened Romberg Test (SRT) with eyes open and closed, the Activities-specific Balance Confidence (ABC) Scale, the Six-Minute Walk Test (6MWT), comfortable and fast gait speed, the Timed "Up & Go" Test (TUG), the Medical Study 36-Item Short-Form Health Survey (SF-36), and the Unified Parkinson Disease Rating Scale (UPDRS) in people with parkinsonism. Thirty-seven community-dwelling adults with parkinsonism (mean age=71 years) participated. The Hoehn and Yahr Scale median score of 2 was on the lower end of the scale; however, the scores ranged from 1 to 4. Subjects were tested twice by the same raters, with 1 week between tests. Test-retest reliability was calculated using intraclass correlation coefficients (ICCs). Minimal detectable change was calculated using a 95% confidence interval (MDC(95)). The ICCs for test-retest reliability were above .90 for the BBS, ABC Scale, SRT with eyes closed, 6MWT, and comfortable and fast gait speeds. The MDC(95) values for those functional tests were: BBS=5/56, ABC Scale=13%, SRT with eyes closed=19 seconds, 6MWT=82 m, comfortable gait speed=0.18 m/s, and fast gait speed=0.25 m/s. The ICCs for test-retest reliability of SF-36 scores were above .80, with the exception of the social functioning subscale. The MDC(95) values for the SF-36 ranged between 19% and 45%. The MDC(95) values for the UPDRS Activities of Daily Living section, Motor Examination section, and total scores were 4/52, 11/108, and 13/176, respectively. Minimal detectable change values are useful to therapists in rehabilitation and wellness programs in determining whether change during or after intervention is clinically significant. High test-retest reliability of scores for the BBS, ABC Scale, SRT with eyes closed, 6MWT, and gait speed make them trustworthy functional assessments in people with parkinsonism. The SF-36 and UPDRS provide quality-of-life and disease severity rating values in the ongoing assessment of people with parkinsonism.

EFFECT OF FLAMINGO EXERCISES ON BALANCE IN PATIENTS WITH BALANCE IMPAIRMENT DUE TO SENILE OSTEOARTHRITIS

Evidence-based medicine and clinical decision-making in spine surgery

Objective To evaluate the clinical value of susceptibility- weighted imaging(SWI) in detecting intramedullary hemorrhage of traumatic acute spinal cord injury. Methods From October 2012 to December 2014, 37 TSCI (traumatic spinal cord injuries) patients undergone the MRI scans including routine MRI and SWI were enrolled. Further according to ASIA classification standard, all patients were evaluated as ASIA A (n=4), ASIA B (n=4), ASIA C (n=19) and ASIA D (n=10). Referring to axial T2WI images at the same slice, the manifestations of hemorrhage in amplitude image, phase image and SWI were evaluated. At the slice with maximal size of hemorrhage area and its neighboring slices, the hemorrhage regions were manually drawn; and the total area was automatically calculated. The number of hemorrhage lesions was defined as the number of hemorrhage lesions at single slice × slice number. One-way ANOVA was used to compare the differences among different grading ASIA in terms of hemorrhage area and number. Meanwhile, the relations between hemorrhage area and ASIA grade; hemorrhage number and ASIA grade were evaluated by Spearman rank correlation. Results The hemorrhage was detected by SWI in 15 patients, including 4 ASIA A, 4 ASIA B, 7 ASIA C. Hemorrhage represents as isointense in T1WI and a slightly low signal intensity or isointense in the center companied by high intensity at circus in T2WI. In magnitude image and SWI hemorrhage appears as low signal intensity and low signal intensity in the center companied by high intensity at circus in phase image. In detecting the hemorrhage, SWI (98 lesions were detected) was 5.4 times of T2WI (19 lesion were detected). As for the number of hemorrhage, significant differences were found among ASIA grading A, B and C (grading A: 22.5±1.3, grading B: 19.5±1.3, grading C: 4.0±1.1; F= 38.720, P<0.01); Further the pairwise comparison showed statistical significance (P<0.05); besides, the number of hemorrhage lesions closely related with the ASIA grade (r=0.864, P<0.01). For the hemorrhage area, the calculated results of grading ASIA A, B and C were (23.5 ± 0.6), (21.8 ± 1.9), (3.9 ± 0.7) mm2, respectively; there were significant differences among the different ASIA grades (F=29.987, P<0.001); furthermore the hemorrhage area also showed closely relation with the ASIA grade (r=0.778, P<0.01). Conclusions SWI is more sensitive in detecting the hemorrhage in traumatic acute spinal cord injury. The more number and area of bleeding area suggest the more severe of the damage level. Key words: Spinal cord injuries; Magnetic resonance imaging; Hemorrhage

Canadian Spine SocietyPresentation CPSS1: Spinal insufficiency fracture in the geriatric pediatric spinePresentation CPSS2: The clinical significance of tether breakages in anterior vertebral body growth modulation: a 2-year postoperative analysisPresentation CPSS3: Anterior vertebral body growth modulation for idiopathic scoliosis: early, mid-term and late complicationsPresentation CPSS4: Ovine model of congenital chest wall and spine deformity with alterations of respiratory mechanics: follow-up from

Study designLongitudinal study.ObjectiveTo explore whether individuals with traumatic spinal cord injury (TSCI) and non-traumatic SCI (NTSCI) experience different trajectories in changes of cardiometabolic disease (CMD) factors during initial rehabilitation stay.SettingMulticenter Swiss Spinal Cord Injury Cohort (SwiSCI) study.MethodsIndividuals without history of cardiovascular diseases were included. CMD factors and Framingham risk score (FRS) were compared between TSCI and NTSCI. Linear mixed models’ analysis was employed to explore the trajectory in CMD factors changes over rehabilitation period and a multivariate linear regression analysis was used at discharge from inpatient rehabilitation to explore factors associated with CMD risk profile in TSCI and NTSCI. We performed age and sex-stratified analyses.ResultsWe analyzed 530 individuals with SCI (64% with TSCI and 36% NTSCI). The median age was 53 years (IQR:39-64) with 67.9% (n = 363) of the study cohort being male. The median rehabilitation duration was 4.4 months (IQR 2.4-6.4). At admission to rehabilitation, FRS (9.61 vs. 5.89) and prevalence of hypertension (33.16% vs. 13.62%), diabetes (13.68% vs. 4.06%), and obesity (79.05% vs. 66.67%) were higher in NTSCI as compared to TSCI, No difference was observed in cardiometabolic syndrome between the groups (around 40% in both groups). Overall, we observed longitudinal increases in total cholesterol, HDL-C and HDL/total cholesterol ratio, and a decrease in fasting glucose over the rehabilitation period. No differences in longitudinal changes in cardiovascular risk factors were observed between TSCI and NTSCI.ConclusionsThere was no deterioration in cardiometabolic risk factors over rehabilitation period, at discharge from initial rehabilitation stay. Both TSCI and NTSCI experienced high burden of cardiometabolic syndrome components with NTSCI experiencing more disadvantageous risk profile. The effectiveness of therapeutic and lifestyle/behavioral strategies to decrease burden of cardiometabolic disease and its components in early phase should be explored in future studies.

Traumatic brain and spinal cord injuries are significant causes of permanent disability and death. In 2010, 823,000 traumatic brain injuries were reported in the United States alone; in fact, the actual number is likely considerably higher because mild traumatic brain injuries and concussions are underreported. The number of new traumatic spinal cord injuries has been estimated at 12,000 annually. Survival from these injuries has increased due to improvements in medical care. This review covers mild traumatic brain injury and concussion, moderate to severe traumatic brain injury, and traumatic spinal cord injury. Figures include computed tomography scans showing a frontal contusion, diffuse cerebral edema and intracranial air from a gunshot wound, a subdural hematoma, an epidural hematoma, a skull fracture with epidural hematoma, and a spinal fracture from a gunshot wound. Tables list requirements for players with concussion, key guidelines for prehospital management of moderate to severe traumatic brain injury, key guidelines for management of moderate to severe traumatic brain injury, brain herniation brain code, key clinical practice guidelines for managing cervical spine and spinal cord injury, and the American Spinal Injury Association’s neurologic classification of spinal cord injury. This review contains 6 highly rendered figures, 12 tables, and 55 references.