Classification Of Spinal Cord Injury Research Articles

Compensatory muscle activation during forced respiratory tasks in individuals with chronic spinal cord injury

When lesions in the spinal cord occur, the neural activation of respiratory muscles is compromised (De Troyer and Heilporn, 1980; De Troyer et al., 1986, 1990; Estenne et al., 2000a) resulting in significant respiratory dysfunction (De Troyer and Heilporn, 1980; Linn et al., 2000, 2001; Yokoba et al., 2003). However the underlying mechanisms that contribute to this dysfunction remain unclear. The aims of this study were: (1) to investigate whether a correlation exists between pulmonary function and the International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI) examination scores for sensory and motor function; (2) to evaluate whether compensatory muscle activation plays a role in pulmonary function after spinal cord injury (SCI). We recorded Forced Vital Capacity (FVC); Forced Expiratory Volume in 1s (FEV1); and electromyography (EMG) of respiratory muscles during maximum respiratory tasks in 36 with SCI and 15 neurologically intact participants. Results indicate that pulmonary function (FVC, FEV1) was strongly correlated with motor and sensory scores from the ISNCSCI exam and maximal expiratory pressure (MEP) was also significantly related to ISNCSCI sensory scores (ρ=0.73, p<.001) and moderately, but significantly correlated to motor scores (ρ=0.41, p=.04). After SCI, there is a compensatory recruitment of accessory muscles upper trapezius during maximal inspiratory pressure (MIP) and pectoralis and latissimus dorsi during MEP that is significantly higher than in non-injured (p<.001).

Predictive Value of Upper Limb Muscles and Grasp Patterns on Functional Outcome in Cervical Spinal Cord Injury

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.

Discrepancies between clinical assessments of sensory function and electrical perceptual thresholds after incomplete chronic cervical spinal cord injury.

Study DesignProspective experimental.ObjectivesTo compare sensory function as revealed by light touch and pin prick tests of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and the electrical perceptual threshold (EPT) exams in individuals with chronic incomplete cervical spinal cord injury (SCI).SettingPittsburgh, United States.MethodsEPT was tested using cutaneous electrical stimulation (0.5 ms pulse width, 3 Hz) in 32 healthy controls and in 17 participants with SCI over key points on dermatomes C2 to T4 on each side of the body. Light touch and pin prick ISNCSCI scores were tested at the same key dermatomes in SCI participants.ResultsIn controls, EPT values were higher in older males (1.26±0.2 mA, mean±s.d.) compared with younger males (1.0±0.2 mA) and older females (0.9±0.2 mA), regardless of the dermatome and side tested. Fifteen out of seventeen SCI participants showed that the level of sensory impairment detected by the EPT was below the level detected by the ISNCSCI (mean=4.5±2.4, range 1–9). The frequency distribution of EPTs was similar to older male controls in dermatomes above but not below the ISNCSCI sensory level. The difference between EPT and ISNCSCI sensory level was negatively correlated with the time post injury.ConclusionsThe results show that, in the chronic stage of cervical SCI, the EPT reveals spared sensory function at lower (~5) spinal segments than the ISNCSCI sensory exam. It is hence found that the EPT is a sensitive tool to assess recovery of sensory function after chronic SCI.

Update for Examination Sheet of International Standards for Neurological Classification of Spinal Cord Injury

Update for Examination Sheet of International Standards for Neurological Classification of Spinal Cord Injury

PD8-08 RISK FACTORS FOR FEBRILE UTI IN SPINAL CORD INJURY PATIENTS WITH ROUTINE CONCOMITANT INTERMITTENT CATHETERIZATION (CIC)

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Kidney & Bladder I1 Apr 2015PD8-08 RISK FACTORS FOR FEBRILE UTI IN SPINAL CORD INJURY PATIENTS WITH ROUTINE CONCOMITANT INTERMITTENT CATHETERIZATION (CIC) Fukashi Yamamichi, Katsumi Shigemura, Shigeto Mukai, Masashi Nomi, Akihiro Yanagiuchi, Atsushi Sengoku, Kazushi Tanaka, Soichi Arakawa, and Masato Fujisawa Fukashi YamamichiFukashi Yamamichi More articles by this author , Katsumi ShigemuraKatsumi Shigemura More articles by this author , Shigeto MukaiShigeto Mukai More articles by this author , Masashi NomiMasashi Nomi More articles by this author , Akihiro YanagiuchiAkihiro Yanagiuchi More articles by this author , Atsushi SengokuAtsushi Sengoku More articles by this author , Kazushi TanakaKazushi Tanaka More articles by this author , Soichi ArakawaSoichi Arakawa More articles by this author , and Masato FujisawaMasato Fujisawa More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.923AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Neurogenic bladder associated with spinal injury may have severe problems in their urinary tract system such as urinary tract infection (UTI). The purpose of this study is to investigate the clinical risk factor for febrile UTI in spinal cord injury-associated neurogenic bladder patients who perform routine concomitant intermittent catheterization (CIC). METHODS We investigated 321 (247 male and 74 female) spinal cord injury patients in these 3 years who were diagnosed as neurogenic bladder and perform routine CIC regarding the such factors febrile UTI, gender, the presence of pyuria and bacteriuria or categories of the American Spinal Injury Association (ASIA) impairment scale (Reference Manual for the International Standards for Neurological Classification of Spinal Cord Injury (Rev. 2003)). We examined to assess the clinical risk factors for febrile UTI. RESULTS Total 77 (24.0 %) patients had febrile UTI in these follow-up periods and 64 cases of pyelonephritis, 11 cases of epididymitis and 2 cases of prostatitis. As to infection events, 145 events of febrile UTI were observed and details were 130 cases of pyelonephritis, 13 cases of epididymitis and 2 cases of prostatitis. The causative bacteria were ranked as follows: Eschelicia coli (81 cases), Pseudomonas aeruginosa (21 cases), Enterococcus faecalis (19 cases) and Kllebsiella pneumoniae (15 cases). Antibiotic resistant E. coli were seen in 10.2 % of ESBL production and 23.8 % of fluoroquinolone-resistance. Our clinical risk factor investigation showed that gender (male, p=0.0023) and ASIA category C or more severe (A or B) (p=0.0040) had significantly associated with febrile UTI occurrence for neurogenic bladder patients with routine CIC in our set factors. This may suggest CIC in male required more skill than female and severe spinal cord injury caused less motor function related to CIC performance and less motor and sensory function related to for bladder function. CONCLUSIONS Our data demonstrated that male and ASIA classification C or more severe impairment in spinal injury-associated neurogenic bladder patients with routine CIC were significant risk factors for febrile UTI. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e193 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fukashi Yamamichi More articles by this author Katsumi Shigemura More articles by this author Shigeto Mukai More articles by this author Masashi Nomi More articles by this author Akihiro Yanagiuchi More articles by this author Atsushi Sengoku More articles by this author Kazushi Tanaka More articles by this author Soichi Arakawa More articles by this author Masato Fujisawa More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Morbidity associated with operative management of bladder stones in spinal cord-injured patients.

Retrospective cohort study of spinal cord-injured (SCI) patients undergoing bladder stone removal operations between 1999 and 2013. To determine the morbidity associated with different operative management of bladder stones in SCI patients. National Spinal Injuries Unit, Stoke Mandeville Hospital, UK. Data on age, sex, level and Frankel classification of spinal cord injury, method of bladder drainage, method of bladder stone removal, complications and length of stay were collected from patient records. Complication was defined as bladder perforation, sepsis or persistent haematuria. Predictors of complications and length of stay were determined using univariate and multivariate regression analyses. Overall, 112 consecutive bladder stone removal operations were performed, one open cystolithotomy and 111 transurethral procedures utilising simple washout, stone punch or electrohydraulic lithotripsy (EHL). Of these procedures, 17% (19/112) had complications; 0/11 (0%) following washout, 5/44 (11%) after stone punch, 3/12 (25%) following EHL and 10/26 (38%) after combined procedures using stone punch and EHL. In a multivariate model, patients with a cervical-level injury and those undergoing a combined procedure were significantly more likely to have a complication (P=0.032 and P=0.046). Length of stay was longer following a complication, the mean was 4.18 days compared with 1.37 days without a complication (P<0.001). Controlling complications and age, use of a combined procedure was associated with significantly longer stay than use of stone punch alone. This study provides important outcome data that should guide operative procedure choice and inform patients about possible risks during consent. It sets a benchmark that other centres can evaluate their outcomes against.

The importance of early detection of spared corticospinal connections to improve functional abilities post-spinal cord injury: A case study

In Australia, 300-400 people sustain a spinal cord injury (SCI) annually. A detailed description of the impact of SCI on sensorimotor control is difficult to achieve with the current clinical assessment, the International Standard for Neurological Classification of Spinal Cord Injury (ISNCSCI). The ISNCSCI is a crude measure and is unable to identify all the spared corticospinal (CS) connections, which can be promoted through appropriate rehabilitation. In tetraplegics, evenmodest improvements in upper limb function can have a substantial impact on their lives. Although electrophysiological methods can complement the clinical evaluation by providing quantitative, objective data about conduction across the SCI site, these techniques are not used routinely in clinical practice. We recently assessed a patient with SCI (5 months post injury) using transcranial magnetic stimulation (TMS) in a rehabilitation centre, to explore the existence of spared CS projections to upper limb muscles, and thus the potential for regaining further functional abilities. His ISNCSCI assessment, categorized his injury as Complete A with neurological level of C4. Since the strength of his Triceps muscles on both sides was recorded as 0/5 during repeated assessments by his therapists, no therapeutic intervention was directed to these muscles during his rehabilitation. Motor evoked potentials were recorded easily from Triceps on both sides, which confirmed the existence of spared CS projections to control the activity of these muscles in this patient. He received EMG-triggered neuromuscular stimulation (10 minutes, x 3 per day) for three weeks. The strength of his Triceps gradually improved to 2/5 on both sides. The stable level of cortical excitability from preto post-training suggests that the improvement in muscle function occurred at the level of the muscle. Electrophysiological assessment can be useful in identifying residual function below the level of injury, which can, in turn, be enhanced through appropriate rehabilitation strategies.

Changes in Strength, Sensation, and Prehension in Acute Cervical Spinal Cord Injury

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.

Changes in Body Temperature in Incomplete Spinal Cord Injury by Digital Infrared Thermographic Imaging.

ObjectiveTo investigate changes in the core temperature and body surface temperature in patients with incomplete spinal cord injuries (SCI). In incomplete SCI, the temperature change is difficult to see compared with complete spinal cord injuries. The goal of this study was to better understand thermal regulation in patients with incomplete SCI.MethodsFifty-six SCI patients were enrolled, and the control group consisted of 20 healthy persons. The spinal cord injuries were classified according to International Standards for Neurological Classification of Spinal Cord Injury. The patients were classified into two groups: upper (neurological injury level T6 or above) and lower (neurological injury level T7 or below) SCIs. Body core temperature was measured using an oral thermometer, and body surface temperature was measured using digital infrared thermographic imaging.ResultsTwenty-nine patients had upper spinal cord injuries, 27 patients had lower SCIs, and 20 persons served as the normal healthy persons. Comparing the skin temperatures of the three groups, the temperatures at the lower abdomen, anterior thigh and anterior tibia in the patients with upper SCIs were lower than those of the normal healthy persons and the patients with lower SCIs. No significant temperature differences were observed between the normal healthy persons and the patients with lower SCIs.ConclusionIn our study, we found thermal dysregulation in patients with incomplete SCI. In particular, body surface temperature regulation was worse in upper SCIs than in lower injuries. Moreover, cord injury severity affected body surface temperature regulation in SCI patients.

Effectiveness of repeated transplantations of hematopoietic stem cells in spinal cord injury.

To evaluate the short and long-term effects of the complex cell therapy of 202 cases of spinal cord injury (SCI). The main arm included 202 cases of SCI and the control arm included 20 SCI cases. For the therapy the hematopoietic stem cells (HSCs) and progenitor cells (PCs) were mobilized to peripheral blood by 8 subcutaneous injections of granulocyte colony-stimulating factor (G-CSF) for 4 d and are harvested at day 5. The cells were administered to the main arm intrathecally every 3 mo for a long term (3-5 years) according to the internal research protocol international medical institute of tissue engineering. Magnetic resonance imaging of the site of injury and urodynamic tests were performed every 6 mo. Motor evoked potentials (MEP), somatosensory evoked potentials (SSEP) were evaluated every 3 mo. The patients were evaluated with american spianl injury association (ASIA) index, functional independence measure index, the Medical Research Council Scale, the International Standards for Neurological Classification of Spinal Cord Injury (ISCSCI-92) and specifically developed scales. The function of bladder was evaluated by a specifically developed clinical scale. The long-term clinical outcomes were assessed for the SCI patients who received no less than 20 intrathecal transplantations of HSCs and hematopoietic precursors (HPs). The restoration of neurologic deficit after HSCs and HPs transplantations was proved stable and evident in 57.4% of the cases. In 42.6% cases no neurologic improvement has been observed. In 50% of the cases the motor restoration began after the first transplantation, which is confirmed in average by 9.9 points improvement in neurologic impairment as compared to the baseline (P < 0.05). Repair of the urinary system was observed in 47.7% of the cases. The sensitivity improved from baseline 124.3 points to 138.4 after the first and to 153.5 points after the second transplantations of HSCs and HPs (P < 0.05, between the stages of research). The evaluation with ASIA index demonstrated regress of neurologic symptoms in 23 cases. Motor progress was also assessed with the ISCISCI-92 motor and sensory scores, and the data coincided with those received with the specifically developed scale. The number of the patients with the signs of locomotive repair was 56.9%. No life threatening complications or adverse effects have been observed. The method is safe, effective and considerably improves the life quality of SCI patients. The therapy is approved for clinical use as the treatment of choice.

International standards for neurological classification of spinal cord injury: classification skills of clinicians versus computational algorithms.

This is a retrospective analysis. The objective of this study was to describe and quantify the discrepancy in the classification of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) by clinicians versus a validated computational algorithm. European Multicenter Study on Human Spinal Cord Injury (EMSCI). Fully documented ISNCSCI data sets from EMSCI's first years (2003-2005) classified by clinicians (mostly spinal cord medicine residents, who received in-house ISNCSCI training by senior SCI physicians) were computationally reclassified. Any differences in the scoring of sensory and motor levels, American Spinal Injury Association Impairment Scale (AIS) or the zone of partial preservation (ZPP) were quantified. Four hundred and twenty ISNCSCI data sets were evaluated. The lowest agreement was found in motor levels (right: 62.1%, P=0.002; left: 61.8%, P=0.003), followed by motor ZPP (right: 81.6%, P=0.74; left 80.0%, P=0.27) and then AIS (83.4%, P=0.001). Sensory levels and sensory ZPP showed the best concordance (right sensory level: 90.8%, P=0.66; left sensory level: 90.0%, P=0.30; right sensory ZPP: 91.0%, P=0.18; left sensory ZPP: 92.2%, P=0.03). AIS B was most often misinterpreted as AIS C and vice versa (AIS B as C: 29.4% and AIS C as B: 38.6%). Most difficult classification tasks were the correct determination of motor levels and the differentiation between AIS B and AIS C/D. These issues should be addressed in upcoming ISNCSCI revisions. Training is strongly recommended to improve classification skills for clinical practice, as well as for clinical investigators conducting spinal cord studies. This study is partially funded by the International Foundation for Research in Paraplegia, Zurich, Switzerland.

P06. Prognostic value of multimodal neurophysiological testing in spinal cord injury

The disability secondary to traumatic spinal cord injury (SCI) is known to be highly variable among patients due to the vast variety of lesion levels and varying severity, resulting in a mixture of central and peripheral neural lesion burden. In this context prognostication of outcome becomes a challenge, yet is paramount in planning rehabilitation and clinical trials. Next to clinical assessment by International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) neurophysiological techniques have been used for diagnosing lesion severity and prognostication as they are objective and early available. Evoked potentials (EPs) have been suggested as diagnostic and prognostic tools in SCI, although their importance and prognostic value has not been completely established. Prognostic significance of multimodal EPs was assessed in a cohort of 633 SCI cases from the European Multicenter Study about Spinal Cord Injury database (EMSCI, www.emsci.org ). SCI patients underwent complete neurophysiological evaluation (NPE) prospectively, including nerve conduction studies, somatosensory and motor EPs within 4 weeks after spinal injury. Functional recovery after SCI as the endpoint was assessed at 3, 6 and 12 months during and after rehabilitation by standardized and validated testing using the international Spinal Cord Independence Measure (SCIM). EPs abnormalities were quantified through an index of global EPs alteration (EP score). The relationship between EP score and disability in SCIM was analyzed by Spearman ρ correlation coefficient. Receiver operated characteristic (ROC) curves were used to determine best EP score cut off values to predict SCIM endpoints within sub-score categories such as mobility and hand function. Significant correlations could be shown between EP score (motor and somatosensory EPs) and SCIM score at the time of NPE and at 3, 6 and 12 months of follow-up. Goodness of fit increased over time indicating true predictive value of early EP assessment for late functional outcome. For each functional sub-score endpoint, significant sensitivity, specificity, positive and negative predictive values were obtained. Multimodal EPs are valuable objective procedures to predict disability in traumatic SCI patients. This prediction can be achieved independent of clinical assessment (ISNCSCI) and without knowledge of lesion level.

Feasibility of using training cases from International Spinal Cord Injury Core Data Set for testing of International Standards for Neurological Classification of Spinal Cord Injury items.

Descriptive comparison analysis. To evaluate whether five training cases of International Spinal Cord Injury Core Data Set (ISCICDS) are appropriate for testing the facts within the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and could thus be used for testing its training effectiveness. The authors reviewed the five training cases from the ISCICDS and determined the sensory level (SL), motor level (ML) and American Spinal Injury Association Impairment Scale (AIS) for the training cases. The key points from the training cases were compared with our interpretation of the key aspects of the ISNCSCI. For determining SL, three principles of ML, sacral sparing, complete injury, classification of AIS A, B, C and D, determining motor incomplete status through sparing of motor function more than three levels below the ML, there are corresponding case scenarios in ISCICDS. However, no case scenario shows classification of AIS E and the use of voluntary anal sphincter contraction for determination of motor incomplete status. Neurological level of injury could be deduced from the SL and ML. Finally, none of the cases include information about zone of partial preservation, sensory score or motor score. Majority of the facts related to SL, ML and AIS are included in the five training cases of ISCICDS. Thus, using these training cases, it is feasible to test the above facts within the ISNCSCI. It is suggested that the missing fact should be included in an update of the training cases.

Outcome of the upper limb in cervical spinal cord injury: Profiles of recovery and insights for clinical studies

BackgroundImproved 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.MethodsAn 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.AnalysisChange over time was plotted using mean and standard deviation of the total and subgroups of the sample.ResultsIndividuals 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.ConclusionsIn 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.

Update for Examination Sheet of International Standards for Neurological Classification of Spinal Cord Injury

Update for Examination Sheet of International Standards for Neurological Classification of Spinal Cord Injury

Activity-Based Therapy for Recovery of Walking in Individuals With Chronic Spinal Cord Injury: Results From a Randomized Clinical Trial

ObjectiveTo examine the effects of activity-based therapy (ABT) on neurologic function, walking ability, functional independence, metabolic health, and community participation. DesignRandomized controlled trial with delayed treatment design. SettingOutpatient program in a private, nonprofit rehabilitation hospital. ParticipantsVolunteer sample of adults (N=48; 37 men and 11 women; age, 18–66y) with chronic (≥12mo postinjury), motor-incomplete (ASIA Impairment Scale grade C or D) spinal cord injury (SCI). InterventionsA total of 9h/wk of ABT for 24 weeks including developmental sequencing; resistance training; repetitive, patterned motor activity; and task-specific locomotor training. Algorithms were used to guide group allocation, functional electrical stimulation utilization, and locomotor training progression. Main Outcome MeasuresNeurologic function (International Standards for Neurological Classification of Spinal Cord Injury); walking speed and endurance (10-meter walk test, 6-minute walk test, and Timed Up and Go test); community participation (Spinal Cord Independence Measure, version III, and Reintegration to Normal Living Index); and metabolic function (weight, body mass index, and Quantitative Insulin Sensitivity Check). ResultsSignificant improvements in neurologic function were noted for experimental versus control groups (International Standards for Neurological Classification of Spinal Cord Injury total motor score [5.1±6.3 vs 0.9±5.0; P=.024] and lower extremity motor score [4.2±5.2 vs −0.6±4.2; P=.004]). Significant differences between experimental and control groups were observed for 10-meter walk test speed (0.096±0.14m/s vs 0.027±0.10m/s; P=.036) and 6-minute walk test total distance (35.97±48.2m vs 3.0±25.5m; P=.002). ConclusionsABT has the potential to promote neurologic recovery and enhance walking ability in individuals with chronic, motor-incomplete SCI. However, further analysis is needed to determine for whom ABT is going to lead to meaningful clinical benefits.

Functional electrical stimulation as a component of activity-based restorative therapy may preserve function in persons with multiple sclerosis

ObjectiveTo examine the effect of functional electrical stimulation (FES) cycling on disability progression in persons with multiple sclerosis (MS).DesignRetrospective cohort, 40 participants with mean follow-up of 15 months.SettingInternational Center for Spinal Cord Injury at Kennedy Krieger Institute in Baltimore, a rehabilitation referral center.ParticipantsForty consecutive persons with MS undergoing rehabilitation from 2007 to 2011, with at least two evaluations based on the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI).InterventionsFES cycling as part of activity-based restorative therapy interventions.Outcome measuresChange in Expanded Disability Status Scale (EDSS) and ISNCSCI motor, light touch, and pin prick scores from baseline to latest evaluation.ResultsIn 71% of patients, activity-based rehabilitation included FES cycling. There was no disability progression on the EDSS. Lower extremity motor scores improved or stabilized in 75% of patients with primary progressive MS (PPMS), 71.4% with secondary progressive MS (SPMS), and 54.5% with relapsing remitting MS (RRMS). Among patients with improved or stabilized lower extremity motor function, PPMS recorded a mean 9% improvement, SPMS 3% and RRMS 6%. In PPMS, use of FES showed trend towards improvement in motor scores (P = 0.070).ConclusionsFES as part of activity-based rehabilitation may help preserve or improve neurological function in patients with MS.

International standards for neurological classification of spinal cord injury: cases with classification challenges.

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.

International Standards for Neurological Classification of Spinal Cord Injury: Cases with classification challenges

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.

Clinical correlates of cerebral diffusion tensor imaging findings in chronic traumatic spinal cord injury

Prospective clinical case-control study. The aim of this study was to use diffusion tensor imaging (DTI) to assess the state of cerebral white matter tracts after spinal cord injury (SCI). The DTI metrics were evaluated in relation to neurological deficits and to the size and level of the spinal cord lesions. Tampere University Hospital, Tampere, Finland. Thirty-four patients (n=34) with clinically complete and incomplete SCI were evaluated using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). DTI metrics (fractional anisotropy (FA) and apparent diffusion coefficient (ADC)) were calculated for multiple levels along the course of the corticospinal tract. The state of the spinal cord after injury was assessed using conventional magnetic resonance imaging (MRI). DTI parameters were compared with 40 orthopedically injured control subjects. Statistically significant differences in the DTI values between patients and controls were detected in the posterior area of the centrum semiovale. In this area, the FA values were lower in the patients compared with controls (P=0.008). For patients with clinically complete injury, the difference was even more significant (P=0.0005). Motor and sensory scores of the ISNCSCI correlated positively with FA and negatively with ADC values of the centrum semiovale. A moderate association was observed between the macroscopic changes in the spinal cord and the DTI abnormalities in the centrum semiovale. In patients with chronic SCI, DTI changes can be observed in the cerebral white matter. These alterations are associated with the clinical state of the patients.