International Standards for Neurological Classification of Spinal Cord Injury

Rupp, Rüdiger; Biering‐Sørensen, Fin; Burns, Stephen P.; Graves, Donald J.; Guest, James D.; Jones, Loring; Read, Mary Schmidt; Rodriguez, Gianna M.; Schuld, Christian; Tansey-Md, Keith E; Walden, Kristen; Kirshblum, Steven

doi:10.46292/sci2702-1

Cited by 172 publications

(138 citation statements)

References 13 publications

Supporting

Mentioning

113

Contrasting

Unclassified

Order By: Relevance

“…Each muscle was scored from 0-5 (Muscle Motor Score; MMS) following the recommendations of the ISNCSCI. 31,40 Thus, the total motor score has a maximum of 50 per side, and 100 per person. The upper extremity motor score (UEMS) consists of a maximum of 25 per side and 50 per person.…”

Section: Methodsmentioning

confidence: 99%

Segmental analysis in cervical spinal cord injury reveals the recovery potential of hand muscles with preserved corticospinal tract: Insights beyond impairment scales

Balbinot

Kalsi‐Ryan

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

Cervical spinal cord injury (SCI) severely impacts widespread bodily functions with extensive impairments for individuals, who prioritize regaining hand function. Although prior work has focused on the recovery at the person- level, the factors determining the recovery potential of individual muscles are poorly understood. There is a need for changing this paradigm in the field by moving beyond person-level classification of residual strength and sacral sparing to a muscle-specific analysis with a focus on the role of corticospinal tract (CST) sparing. The most striking part of human evolution involved the development of dextrous hand use with a respective expansion of the sensorimotor cortex controlling hand movements, which, because of the extensive CST projections, may constitute a drawback after SCI. Here, we investigated the muscle-specific natural recovery after cervical SCI in 748 patients from the European Multicenter Study about SCI (EMSCI), one of the largest datasets analysed to date. All participants were assessed within the first 4 weeks after SCI and re-assessed at 12, 24, and 48 weeks. Subsets of individuals underwent electrophysiological multimodal evaluations to discern CST and lower motor neuron (LMN) integrity [motor evoked potentials (MEP): N = 203; somatosensory evoked potentials (SSEP): N = 313; nerve conduction studies (NCS): N = 280]. We show the first evidence of the importance of CST sparing for proportional recovery in SCI, which is known in stroke survivors to represent the biological limits of structural and functional plasticity. In AIS D, baseline strength is a good predictor of segmental muscle strength recovery, while the proportionality in relation to baseline strength is lower for AIS B/C and breaks for AIS A. More severely impaired individuals showed non-linear and more variable recovery profiles, especially for hand muscles, while measures of CST sparing (by means of MEP) improved the prediction of hand muscle strength recovery. Therefore, assessment strategies for muscle-specific motor recovery in acute SCI improve by accounting for CST sparing and complement gross person-level predictions. The latter is of paramount importance for clinical trial outcomes and to target neurorehabilitation of upper limb function, where any single muscle function impacts the outcome of independence in cervical SCI.Graphical abstractSegmental analysis in cervical spinal cord injury reveals the recovery potential of hand muscles with preserved corticospinal tract: Insights beyond impairment scales. (A, upper panels) Cervical SCI (yellow) may cause impairment of motor function below the level of lesion depending on the completeness of the injury. Individuals with a sensorimotor complete lesion (AIS A), as defined by the absence of sacral sparing, show a non-proportional strength recovery as related to the baseline strength, in contrast to less severely affected patients (AIS B-D) - reflecting the limitations on structural and functional plasticity in this group. (A, lower panel) The area of spinal cord damage typically extents across several segments below the level of lesion with variable preservation of muscle innervation and is described as zone of partial preservation (ZPP). (B) The recovery of hand muscle strength is more challenged compared to more proximal muscles when accounting for the distance from the level of lesion. (C, upper panel) The strength recovery of proximal muscles is proportional to the baseline strength in AIS D (great R2 values) but limited in AIS A, likely indicating the limits of recovery in severe SCI. (C, lower panel) Also, additional clinical baseline variables [e.g., distance from the motor level of injury (DST); pin prick (PP) and light touch (LT) sensation] primarily increased the prediction of strength recovery for proximal muscles, becoming less effective in more distal muscles, such as the intrinsic hand muscles. (D) Overall, the proportional prediction of strength recovery in distal hand muscles is less strong while failing in AIS A (inversion of proportionality). (D, lower panel) The addition of neurophysiological baseline measures related to CST integrity (by means of MEP) increased the prediction of strength recovery of hand muscles, indicating the importance of residual CST projections to spinal motoneurons for hand strength recovery. Clinical studies aiming at restitution of hand function after SCI may benefit from the addition of MEP assessments early after the SCI, to unveil hand muscles with a potential for recovery.

show abstract

Section: Methodsmentioning

confidence: 99%

Segmental analysis in cervical spinal cord injury reveals the recovery potential of hand muscles with preserved corticospinal tract: Insights beyond impairment scales

Balbinot

Kalsi‐Ryan

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…To the best of our knowledge, this study is the first to use proprioception of the ankle and knee to evaluate end-effector RAGT effects in SCI patients. Only three articles have been published regarding end-effector RAGT in SCI patients [16,17,19]. One of them evaluated BBS for outcome measures, but this was a feasibility study in two patients with SCI [17].…”

Section: Discussionmentioning

confidence: 99%

“…A grade of 1 (impaired) indicates that the patient can consistently report joint movement with 8 of 10 correct answers only on large movement of the joint. A grade of 2 (normal) indicates that the patient can consistently report joint movement with 8 of 10 correct answers both small (approximately 10 • of motion) and large movement [19]. Our purpose in evaluating proprioception was to reveal the effects of the end-effector robot on proprioception.…”

Section: Outcome Measuresmentioning

confidence: 99%

Effects on the Motor Function, Proprioception, Balance, and Gait Ability of the End-Effector Robot-Assisted Gait Training for Spinal Cord Injury Patients

et al. 2021

View full text Add to dashboard Cite

The primary aim of this study was to reveal the effects of end-effector robot-assisted gait training (RAGT) on motor function, proprioception, balance, and gait ability in patients with incomplete spinal cord injury (SCI). The secondary aim was to determine the correlation between clinical outcomes. This study was a prospective and multi-center study. A total of 13 incomplete SCI patients who met inclusion criteria received 30 min of RAGT with Morning Walk® (Curexo, Seoul, South Korea), and 1 h of conventional physiotherapy 5 times per week for 4 weeks. Clinical outcome measures were 10 m walk test (10MWT), 6 min walk test (6mWT), lower extremity motor score (LEMS), proprioception, Berg Balance Scale (BBS), and Walking Index for Spinal Cord Injury (WISCI)-II. All participants were assessed within 48 h before and after the intervention. All clinical outcomes were statistically improved after RAGT. Subgroup analysis according to the initial proprioception, WISCI-II in the normal group showed a statistically significant improvement compared to the abnormal group. Initial BBS and WISCI-II had a positive correlation with most of the final clinical outcomes. The final BBS had a strong positive correlation with the final 10MWT, 6mWT, and WISCI-II. Initial proprioception had a positive correlation with the final WISCI-II. The final proprioception also had a moderate positive correlation with 6mWT and BBS. This study’s results suggest that the end-effector RAGT could promote proprioception, balance ability and walking ability. Postural control ability and proprioception also had a positive relationship with gait ability.

show abstract

“…Immediate post-operative CT cervical spine imaging was unremarkable. Clinically, he was classified as incomplete tetraplegia, C5 American Spinal Injury Association (ASIA) impairment scale B (AIS B) SC injury [22] .…”

Section: Case Presentationmentioning

confidence: 99%

Anterior cervical pseudomeningocele causing syncope after spinal surgery: A case report

Ehsanian

Ali

Singh

et al. 2022

International Journal of Surgery Case Reports

View full text Add to dashboard Cite

Introduction and importance Pseudomeningocele formation from incidental durotomy is a known risk in spine surgery. We present a case of incidental durotomy leading to anterior neck pseudomeningocele, compressing the carotid body (CB) resulting in syncopal episodes. To our knowledge, this is the first case report implicating syncopal episodes to CB compression via a pseudomeningocele. Case presentation A mid sixty-year-old patient with history of obesity, hypertension, and diabetes presented with gait impairment and hand weakness. Ossification of posterior longitudinal ligament (OPLL) was diagnosed with computed tomography imaging (CT) and magnetic resonance imaging (MRI). Elective surgery was completed with an anterior and posterior approach for decompression and fusion. Hospital course (San Jose, CA, USA) was complicated by respiratory depression and incomplete tetraplegia. On post-operative day (POD) six, CT revealed anterolateral soft tissue neck swelling; subsequent CT and MRI showed fluid collection expansion, with associated syncopal episodes on POD thirty-nine. Despite interventional radiology drainage, the fluid collection and symptoms returned five days later. The patient ultimately underwent durotomy revision and repair with muscle patch. Clinical discussion This case highlights the challenges in managing anterior cervical dural tears resulting in pseudomeningocele. Risk factors include anterior cervical corpectomy and decompression, as well as an underlying diagnosis of OPLL. Untreated dural tears may develop into pseudomeningoceles which can contribute to life-threatening outcomes. Conclusion This case report presents the serious consequences of incidental durotomy, the unique post-surgical complication of syncope due to compression of the CB from a pseudomeningocele, and the challenges of managing a persistent pseudomeningocele.

show abstract

International Standards for Neurological Classification of Spinal Cord Injury

Cited by 172 publications

References 13 publications

Segmental analysis in cervical spinal cord injury reveals the recovery potential of hand muscles with preserved corticospinal tract: Insights beyond impairment scales

Segmental analysis in cervical spinal cord injury reveals the recovery potential of hand muscles with preserved corticospinal tract: Insights beyond impairment scales

Effects on the Motor Function, Proprioception, Balance, and Gait Ability of the End-Effector Robot-Assisted Gait Training for Spinal Cord Injury Patients

Anterior cervical pseudomeningocele causing syncope after spinal surgery: A case report

Contact Info

Product

Resources

About