Spinal Cord Injury Independence Measure Research Articles

Multi-center, single-blind randomized controlled trial comparing functional electrical stimulation therapy to conventional therapy in incomplete tetraplegia.

BackgroundLoss of upper extremity function after tetraplegia results in significant disability. Emerging evidence from pilot studies suggests that functional electrical stimulation (FES) therapy may enhance recovery of upper extremity function after tetraplegia. The aim of this trial was to determine the effectiveness of FES therapy delivered by the Myndmove stimulator in people with tetraplegia.MethodsA multi-center, single-blind, parallel-group, two-arm, randomized controlled trial was conducted comparing FES to conventional therapy in adults (≥18 years) with C4–C7 traumatic incomplete tetraplegia between 4 and 96 months post-injury, and with a baseline spinal cord injury independence measure III -self-care (SCIM III-SC) score of ≤10. Participants were enrolled at four SCI-specialized neurorehabilitation centers in the U.S. and Canada. Participants were stratified by center and randomized in a 1:1 ratio to receive either 40 sessions of FES or conventional therapy targeting upper extremities over a 14-week period. Blinded assessors measured SCIM III, Toronto Rehabilitation Institute Hand Function Test, and Graded Redefined Assessment of Strength, Sensibility, and Prehension at baseline, after 20th session, after 40th session or 14 weeks after 1st session, and at 24 weeks after 1st session. The primary outcome measure was change in SCIM III-SC from baseline to end of the treatment. Based on the primary outcome measure, a sample size of 60 was calculated. Seventeen participants' progress in the study was interrupted due to the COVID-19 lockdown. The protocol was modified for these participants to allow them to complete the study.ResultsBetween June 2019 to August 2021, 51 participants were randomized to FES (n = 27) and conventional therapy (n = 24). Both groups gained a mean of 2 points in SCIM-SC scores at the end of treatment, which was a clinically meaningful change. However, there was no statistically significant difference between the groups on any outcomes.ConclusionForty sessions of FES therapy delivered by the MyndMove stimulator are as effective as conventional therapy in producing meaningful functional improvements that persist after therapy is completed. Limitations of this study include the impact of COVID-19 limiting the ability to recruit the target sample size and per-protocol execution of the study in one-third of the participants.RegistrationThis trial is registered at www.ClinicalTrials.gov, NCT03439319.

Impact of spasticity on functioning in spinal cord injury: an application of graphical modelling.

To identify the impact of moderate-to-severe spasticity on functioning in people living with spinal cord injury. Secondary analysis of cross-sectional survey data using graphical modelling. Individuals (n = 1,436) with spinal cord injury aged over 16 years with reported spasticity problems. Spasticity and 13 other impairments in body functions were assessed using the spinal cord injury Secondary Conditions Scale. Impairments in mental functions were assessed using the Mental Health subscale of the 36-item Short Form (SF-36). Independence in activities was measured with the Spinal Cord Injury Independence Measure Self-Report. Restrictions in participation were measured with the Utrecht Scale for Evaluation Rehabilitation - Participation. Fifty-one percent of participants reported moderate-to-severe spasticity. Graphical modelling showed that Chronic pain, Contractures, Tiredness, Doing housework, and Respiratory functions were associated with spasticity and were the top 5 potential targets for interventions to improve the experience of spasticity. The associations and intervention targets were dependent on the level and completeness of the lesion. This is the first application of graphical modelling in studying spasticity in people living with spinal cord injury. The results can be used as a basis for studies aiming to optimize rehabilitation interventions in people with moderate-to-severe spasticity.

Effectiveness of occupational therapy in improving activities of daily living performance in complete cervical tetraplegic patients; A quasi experimental study.

Objective:To determine the effectiveness of Occupational therapy (OT) in improving activities of daily living performance in complete cervical tetraplegic patients.Methods:A quasi experimental study was conducted at Paraplegic Center Peshawar from May 2018 to March 2019. Seventy two spinal cord injury patients with complete cervical tetraplegia having age 18-60 years were included in the study using non probability convenience sampling technique. A trained Occupational therapist conducted two occupational therapy sessions per day, three times a week on alternative days for a period of six weeks. Self-care portion of Spinal cord injury independence measure (SCIM) was used to collect pre and post data. Data was analyzed using SPSS version 20.Results:Mean age of the participants was 30.21±13.52.Majority of the participants were (n= 61, 84.7%) male while remaining 11 (15.3%) participants were female. Pre self-care total score was 0.39±0.987 and post self-care total score was 7.17±5.536. There was significant differences (P value <0.05) between pre and post scores of feeding, upper & lower body bathing, upper & lower body dressing, grooming and total self-care scores.Conclusion:Occupational therapy significantly improves activities of daily living performance in complete cervical tetraplegic spinal cord injury patients.

Implementing a self-management mobile app for spinal cord injury during inpatient rehabilitation and following community discharge: A feasibility study

Objective: To determine the feasibility of implementing and evaluating a self-management mobile app for spinal cord injury (SCI) during inpatient rehabilitation and following community discharge. Design: Pilot feasibility study. Setting: Rehabilitation hospital and community. Participants: Inpatients from rehabilitation hospital following admission for their first SCI. Intervention: A mobile app was developed to facilitate self-management following SCI. The app consisted of 18 tools focusing on goal setting, tracking various health aspects, and identifying confidence regarding components of self-management. In-person training and follow-up sessions were conducted during inpatient rehabilitation and follow-up calls were provided after participants were discharged into the community. Main outcome measures: Participants completed outcome measures at baseline, community discharge, and 3-months post discharge. This study focused on feasibility indicators including recruitment, retention, respondent characteristics, adherence, and app usage. Additionally, participants’ self-management confidence relating to SCI (e.g. medication, skin, bladder, pain) was evaluated over time. Results: Twenty participants (median age 39, IQR: 31 years, 85% male) enrolled in the study. Participants’ Spinal Cord Injury Independence Measure (SCIM-III) median score was 23 and IQR was 33 (range: 7–84), which did not correlate with app usage. Retention from admission to discharge was 85% and 70% from discharge to 3-months post discharge. Individuals in the study who used the app entered data an average of 1.7x/day in rehabilitation (n = 17), and 0.5x/day in the community (n = 7). Participants’ bowel self-management confidence improved between admission and discharge (P < 0.01). Conclusions: Feasibility indicators support a larger clinical trial during inpatient rehabilitation; however, there were challenges with retention and adherence following community discharge.

Spinal cord injury due to fall from electricity poles after electrocution.

Objective:The objective of this study was to report epidemiology, complications and rehabilitation outcomes of patients who sustained spinal cord injury (SCI) due to fall from electricity poles after electrocution.Methods:A prospective observational study was conducted in which patients admitted to Paraplegic Centre Peshawar from July 2016 to July 2018 who sustained SCI due to fall from electricity poles after electrocution were included. Of total 852 patients, 39 (4.58%) sustained SCI due to fall from electricity poles after electrocution. Two patients were excluded and data of 37 patients was analyzed.Results:The mean age of the participants was 35.03±13.47 years. Twenty-two (59.4%) patients had associated burns on different parts of body. Twenty-seven (72.9%) had pressure ulcers, 31 (83.8%) had spasticity, 18 (48.6%) had neuropathic pain and 2 (5.4%) had limb amputations due to injury. Mean Spinal cord injury independence measure score at the time of discharge was 53.4±5.7.Conclusion:SCI due to fall from electricity poles after electrocution is rare however combined effect of injury by electricity along with fall from electricity poles are associated with severe complications. Rehabilitation outcomes in these patients are also minimal

Validation of the short version of the Van Lieshout Test in an Italian population with cervical spinal cord injuries: a cross-sectional study.

Psychometric study. To validate the Italian version of the Van Lieshout Test Short Version (VLT-SV) with a spinal cord injury population. Three Italian spinal units. The Italian version of the VLT-SV (VLT-SV-IT) was administered to a sample of people with cervical spinal cord injuries (C-SCI) and the test-retest was performed. Reliability was assessed using Cronbach's alpha for internal consistency and the intraclass correlation coefficient for repeatability assessment (test-retest). Pearson's correlation coefficient was calculated for concurrent validity with the Italian version of the Jebsen-Taylor Hand Function Test (JTHFT) and for construct validity with the Italian version of the Spinal Cord Injury Independence Measure (SCIM III). The VLT-SV-IT was administered to 61 individuals and all psychometric properties were significant: Cronbach's alpha was 0.95 (left hand and right hand) and the intraclass correlation coefficient for test-retest reliability was 0.90 for the right hand, the left hand, and the total score. Pearson's correlation coefficient of the VLT-SV-IT with the JTHFT was significant, while the correlation with SCIM III was not. The obtained values are considered acceptable and consistent with international guidelines. The VLT-SV-IT was shown to be a reliable and valid assessment tool for measuring hand function in the Italian population with C-SCI. This result suggests that it could be used as a starting point for hand therapy and to assist in clinical decision-making regarding treatment policy.

Implementation of clinical quality management including standardized reporting and individualized management during first rehabilitation of patients with spinal cord

Clinical quality management (QM) during acute and post-acute rehabilitation after newly acquired spinal cord injury (SCI) remains challenging due to complex impaired functioning including bio-psycho-social aspects. International societies developed recommendation for standardized reporting with respect to the international classification of functioning (ICF). However, there is still a lack of implementation of these recommendations. Therefore, this study aims to analyze reasons and create strategies to implement these guidelines in daily practice. Situation analyses, consensus process and requirement analyses of clinical QM in a specialized SCI rehabilitation centre. SCI specific and validated assessments were applied consequently after newly acquired SCI when a controlling system existed (e.g., Spinal Cord Injury independence Measure III: SCIM III) and partly with recommendation (e.g., International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI)). The individual management appeared complex and could not be easily reported in a standardized and comparable way. The leadership decided to use a consensus process to develop an assessment standard according to national and international requirements (Common Data Elements, EMSCI, SwiSCI, ICF Core Sets, association of national quality (ANQ)). For data and process based management the information technology (IT) had to fulfil different requirements (reminder system, clear visibility, connectivity of information). Education tools in specific health professional groups concerning the goal-orientated use of assessments were needed to increase knowledge and to use the assessments. Improvement in patient-centred communication and interdisciplinary team culture optimized the individualized rehabilitation management. Implementation of QM during acute and post-acute care after SCI succeeds when respecting national and international standards, when clinical IT systems are integrated in the decision making, when health professionals are aware of patient-centred communication and continuous education covering these aspects takes place. Change management may happen when representatives of all intended groups are engaged and adequate resources available.

Preferences of adults with spinal cord injury for widely used health-related quality of life and subjective well-being measures

Objective: To describe preferences for survey instruments on health-related quality of life (HRQOL) and subjective well-being (SWB) among adults with spinal cord injury (SCI), and compare perspectives on the instruments between the United States and the United Kingdom.Design: We conducted 20 in-depth interviews.Setting: Participants were interviewed in their homes, some in person and some via Skype.Participants: A convenience sample of 20 adults with SCI (10 in the US and 10 in the UK) were recruited via print and on-line advertisements.Interventions: Not applicable.Main Outcome Measures: Interviewees reviewed six instruments and rated how important it was for their medical providers to know answers to each survey. Two coders analyzed verbatim transcriptions independently using an inductive approach. Keyword-in-context (KWIC) analysis identified the most frequently used words by interviewees to discuss the merits of each instrument.Results: Participants in both samples identified the Fatigue Severity Scale (FSS) as “vital” that their medical providers know about it. This was followed by the Spinal Cord Injury Independence Measure III, and a stand-alone Eudaimonic Well-Being question. The KWIC analysis showed that the most distinctive words used to discuss FSS were “fatigue” and “pain.”Conclusions: Understanding what HRQOL and SWB measures are valued by adults living with SCI can lead to selection of informative instruments, which could help clinicians to complement and tailor established care and rehabilitation protocols for individual needs. Participants identified fatigue as a significant issue, and the FSS as a vitally important instrument to share with medical providers.

Graphical modelling: a tool for describing and understanding the functioning of people living with a health condition.

Rehabilitation aims to optimize people's lived experience of health or functioning. A comprehensive understanding of people's functioning is thus fundamental for rehabilitation clinicians and scientists. Over the past ten years it has been shown that graphical modelling is a promising technique for modelling data on people's functioning. It can contribute to our understanding of the complex associations between domains of functioning and the identification of potential targets for rehabilitation interventions both at the level of the person and the environment. The objective of this methodological note is to demonstrate how graphical modelling can be used by rehabilitation clinicians and scientists in the description, understanding and influencing of people's functioning. The application of graphical modelling and the interpretation of results is illustrated using the Spinal Cord Injury Independence Measure - Self Report used in the Swiss Spinal Cord Injury Cohort Study. Finally, we discuss the potential of graphical modelling for the planning of studies that expand our understanding of functioning and for rehabilitation interventions.

Effect of Overground Training Augmented by Mental Practice on Gait Velocity in Chronic, Incomplete Spinal Cord Injury

ObjectiveTo compare the efficacy of a regimen combining mental practice (MP) with overground training (OT) with the efficacy of a regimen consisting of OT only on gait velocity and lower extremity motor outcomes in individuals with chronic (>12mo postinjury), incomplete spinal cord injury (SCI). DesignRandomized, controlled, single-blinded study. SettingOutpatient rehabilitation laboratories. ParticipantsSubjects with chronic, incomplete SCI (N=18). InterventionsSubjects were randomly assigned to receive (1) OT only, occurring 3d/wk for 8 weeks; or (2) OT augmented by MP (MP + OT), during which randomly assigned subjects listened to an MP audio recording directly after OT sessions. Main Outcome MeasuresSubjects were administered a test of gait velocity as well as the Tinetti Performance Oriented Mobility Assessment, Spinal Cord Injury Independence Measure, and Satisfaction With Life Scale on 2 occasions before intervention, 1 week after intervention, and 12 weeks after intervention. ResultsA significant increase in gait velocity was exhibited across subjects at both 1 week posttherapy (P=.005) and at 12 weeks posttherapy (P=.006). However, no differences were seen in intervention response at either 1 or 12 weeks postintervention among subjects in the MP + OT group versus the OT-only group. ConclusionsOT was associated with significant gains in gait velocity, and these gains were not augmented by further addition of MP.

Georgetown University's Graduate Program in Complementary and Alternative Medicine: Ten Year Review

To compare the efficacy of a regimen combining mental practice (MP) with overground training (OT) with the efficacy of a regimen consisting of OT only on gait velocity and lower extremity motor outcomes in individuals with chronic (>12mo postinjury), incomplete spinal cord injury (SCI).Randomized, controlled, single-blinded study.Outpatient rehabilitation laboratories.Subjects with chronic, incomplete SCI (N=18).Subjects were randomly assigned to receive (1) OT only, occurring 3d/wk for 8 weeks; or (2) OT augmented by MP (MP + OT), during which randomly assigned subjects listened to an MP audio recording directly after OT sessions.Subjects were administered a test of gait velocity as well as the Tinetti Performance Oriented Mobility Assessment, Spinal Cord Injury Independence Measure, and Satisfaction With Life Scale on 2 occasions before intervention, 1 week after intervention, and 12 weeks after intervention.A significant increase in gait velocity was exhibited across subjects at both 1 week posttherapy (P=.005) and at 12 weeks posttherapy (P=.006). However, no differences were seen in intervention response at either 1 or 12 weeks postintervention among subjects in the MP + OT group versus the OT-only group.OT was associated with significant gains in gait velocity, and these gains were not augmented by further addition of MP.

Quality of Residual Neuromuscular Control and Functional Deficits in Patients with Spinal Cord Injury

Study Design: Prospective cohort study.Objective: This study examined the relationship between motor control and clinical function outcomes after spinal cord injury (SCI).Setting: University of Louisville, Louisville, KY, USA.Materials: Eleven persons with SCI and 5 non-injured subjects were included in this study.Methods: The ASIA Impairment Scale (AIS) was used to categorize injury level and severity. Multi-muscle, surface EMG (sEMG) recording, was carried out using a protocol of reflex and volitional motor tasks and was analyzed using a vector-based tool that calculates index values that relate a distribution of multi-muscle activation pattern of each SCI subject to the prototype obtained from non-injured subject group and presents overall magnitude as a separate value. Functional Independence Measure motor sub-scale, Spinal Cord Injury Independence Measure (SCIM-III), and Walking Index for Spinal Cord Injury (WISCI) scale scores were compared to neurophysiological parameters.Results: AIS category and injury level correlated significantly with the WISCI and SCIM mobility sub-scales. sEMG-derived parameters were significantly correlated with SCIM and WISCI scores but only for examinations carried out 48 or more days post-injury.Conclusion: These results supported the hypothesis that clinically relevant function after SCI is related to the degree to which functional organization within the central nervous system is disrupted. Further, due likely to the constraints placed on the expression of functional ability by early post-injury immobilization and hospitalization, neurophysiological assessment of motor function may provide better sensitivity and reliability than can be obtained using the clinical function scales examined here within the early period after injury.