Characterization of neurological recovery following traumatic sensorimotor complete thoracic spinal cord injury

Zariffa, José; Kramer, John L.K.; Fawcett, James W.; Lammertse, Daniel P.; Blight, Andrew R.; Guest, James D.; Jones, Loring; Burns, Stephen P.; Schubert, Martin; Bolliger, Marc; Curt, Armin; Steeves, John D.

doi:10.1038/sc.2010.140

Cited by 98 publications

(87 citation statements)

References 25 publications

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“…2 To date there is an understanding of the extent of recovery in the tetraplegia subgroup based mainly on ISNCSCI UEM scores, LEM scores, and AIS grade. 3,4,20 The work presented in this study provides the field with some new preliminary findings that represent recovery according to a more sensitive upper extremity measure. The recovery profiles, although, from a small sample do inform the clinician and researcher of some of the more subtle sensory and motor changes occurring during the 1-year timecourse, which have the potential to inform study/trial design as well as clinical decision-making.…”

Section: Kalsi-ryan Et Al Upper Limb Recovery Profilesmentioning

confidence: 87%

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

Kalsi-Ryan¹,

Beaton²,

Curt³

et al. 2014

The Journal of Spinal Cord Medicine

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Background: Improved appreciation of recovery profiles of sensory and motor function as well as complex motor functions (prehension) after cervical spinal cord injury (SCI) will be essential to inform clinical studies to consider primary and secondary outcome measures for interventions and the optimization of dosing and timing of therapies in acute and chronic SCI. Objectives: (1) To define the sensory, motor, and prehension recovery profiles of the upper limb and hand in acute cervical SCI and (2) to confirm the impact of AIS severity and conversion on upper limb sensorimotor recovery. Methods: An observational longitudinal cohort study consisting of serial testing of 53 patients with acute cervical SCI was conducted. International Standards of Neurological Classification of Spinal Cord Injury, Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP), Capabilities of Upper Extremity (CUE-Q) Questionnaire, and Spinal Cord Independence Measure III (SCIM-III) were administered at 0-10 days, 1, 3, 6, and 12 months. Analysis: Change over time was plotted using mean and standard deviation of the total and subgroups of the sample. Results: Individuals with traumatic tetraplegia show distinct patterns of recovery. Factors that distinguish homogeneous subgroups of the sample are: severity of injury (level of injury, completeness) at baseline and conversion from a complete to an incomplete injury. Conclusions: In cervical SCI, clinical recovery can be assessed using standardized measures that distinguish levels of activity and impairment. Specific recovery profiles of the upper limb over the 1-year timecourse provide new insights and opportunity for combined analysis of recovery profiles for different clinical assessment tools of upper limb function which are meaningful to inform the design of study protocols.

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Section: Kalsi-ryan Et Al Upper Limb Recovery Profilesmentioning

confidence: 87%

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

Kalsi-Ryan¹,

Beaton²,

Curt³

et al. 2014

The Journal of Spinal Cord Medicine

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“…The independent statistical evaluation of the data regarding neurological scoring (that is, conversion rates, changes in motor and sensory scores) have been shown to be comparable between the data sources when looking at mean changes of upper and lower extremity motor scores (UEMS, LEMS), both in absolute values and in terms of the time course of change, underscored by a more profound spontaneous recovery within the first 12-24 weeks, followed by a stable plateau thereafter. 12,13 This is remarkable considering the separate datasets were collected over relatively long-time periods, with different goals (that is, clinical trials versus registries) and in diverse countries having different standards of care and rehabilitation. More importantly, the similar outcomes provide confidence that the observed natural history of SCI is valid.…”

Section: Translation Of Outcome Measuresmentioning

confidence: 99%

The translational dialogue in spinal cord injury research

Curt

2011

Spinal Cord

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Background: Although the emphasis in clinical spinal cord injury (SCI) research has been directed towards the evaluation of clinical assessments (standards in neurological examination) and the appreciation of outcome measures (that is, extent and pattern of clinical recovery from SCI), the underlying neurological mechanisms for recovery from SCI are not well documented in humans. However, to improve the translational research, a meaningful preclinical-clinical dialogue is required, with an appreciation for both fundamental neural mechanisms and what makes human SCI unique. This holds true both for potential interventions in rehabilitation and novel drug or cell-based treatment approaches in acute SCI. Objectives: The gap in translational research that needs to be approached from both ends not only includes the appreciation of principal neural mechanisms (repair, sprouting, plasticity) and their assumed impact onto outcomes (even though humans and non primate animals may rely on slightly different supraspinal control for some movements), but also includes an understanding of the spatial (location and size of lesion) and temporal (timelines of damage and recovery) factors in spinal cord damage that can vary considerably between the different species being studied. Conclusion:The preclinical-clinical dialogue should be encouraged as a venue to improve the appreciation of discoveries in basic research, and to power valid discoveries towards a meaningful translation into advanced treatments downstream. Similarly, the upstream identification of appropriate clinical targets that take into account clinical constraints depends on reliable and advanced clinical information being provided to preclinical investigators.

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“…5 There is also evidence that changes in PP level are more useful than either LT or motor scores for assessing changes in neurological level of injury with recovery. 6,11,[13][14][15] The reason why preservation of PP appears to be such a good prognosticator of potential recovery may well be related to the present findings that the level of injury is most commonly determined by the PP assessment. As PP sensation correlates particularly well with motor recovery, 6,16 we now suggest that it would be useful to ascertain whether, in addition simply to preserved PP sensation, 14 the difference between LT and PP scores, and their indication of spinal level, may also have some direct relationship to the degree of motor and functional recovery.…”

Section: Discussionmentioning

confidence: 68%

Light touch and pin prick disparity in the International Standard for Neurological Classification of Spinal Cord Injury (ISNCSCI)

et al. 2013

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Study design: Retrospective review. Objectives: The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) assesses cutaneous sensibility through light touch (LT) and sharp-dull discrimination, referred to as pin prick (PP). This project aimed to confirm a tendency for LT to score higher than PP in SCI subjects and discuss possible reasons for such disparity. Setting: Single site cohort study, the London Spinal Cord Injury Centre, United Kingdom. Methods: A retrospective analysis of LT and PP scores of 99 spinal cord injury subjects at the time of discharge (median 5 months) from acute care and rehabilitation in the London Spinal Cord Injury Centre was conducted. Subjects were aged 10-88 years (median 44 years; 78 men, 74 traumatic, 25 non-traumatic). There were 40 American Spinal Injury Association (ASIA) Impairment Scale (AIS) A, 7 B, 18 C and 34 D subjects. Results: A disparity (Po0.001) was found between LT (64.5 ± 3.2, mean ± s.e.) and PP (54.7 ± 2.9) AIS sensory scores. A similar difference in score (LT4PP) was registered both for traumatic and non-traumatic injury, but was greater for incomplete than for complete injury. Despite the difference, LT was well correlated with PP (R ¼ 0.87, Po0.001). Spinal segmental level of injury was determined more frequently by PP alone (43 of 99) than by LT (10 of 99) alone. Conclusion: The discrepancies between LT and PP could relate to the greater complexity of the PP test or a difference in the extent of injury to the posterior columns (LT) and spinothalamic (PP) tracts. Further interpretation would benefit from additional electrophysiological sensory tests.

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Characterization of neurological recovery following traumatic sensorimotor complete thoracic spinal cord injury

Cited by 98 publications

References 25 publications

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

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

The translational dialogue in spinal cord injury research

Light touch and pin prick disparity in the International Standard for Neurological Classification of Spinal Cord Injury (ISNCSCI)

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