Motor and sensory recovery following incomplete tetraplegia

Waters, Robert L.; Adkins, Rodney H.; Yakura, Joy S.; Sie, Ien

doi:10.1016/0003-9993(94)90034-5

Cited by 366 publications

(273 citation statements)

References 4 publications

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“…[2][3][4][5][6][7][8] The data from the placebo-control groups in these studies allow the natural history of recovery from injury to be examined within the context of a randomized controlled trial (RCT). In addition, there have been a number of studies of long-term outcomes after SCI that provide valuable information on expected recovery rates, [10][11][12] as well as some recently unpublished data from the European Multicenter study in Spinal Cord Injury (EMSCI).…”

Section: Sources Of Datamentioning

confidence: 99%

Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP panel: spontaneous recovery after spinal cord injury and statistical power needed for therapeutic clinical trials

et al. 2006

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The International Campaign for Cures of Spinal Cord Injury Paralysis (ICCP) supported an international panel tasked with reviewing the methodology for clinical trials in spinal cord injury (SCI), and making recommendations on the conduct of future trials. This is the first of four papers. Here, we examine the spontaneous rate of recovery after SCI and resulting consequences for achieving statistically significant results in clinical trials. We have reanalysed data from the Sygen trial to provide some of this information. Almost all people living with SCI show some recovery of motor function below the initial spinal injury level. While the spontaneous recovery of motor function in patients with motor-complete SCI is fairly limited and predictable, recovery in incomplete SCI patients (American spinal injury Association impairment scale (AIS) C and AIS D) is both more substantial and highly variable. With motor complete lesions (AIS A/AIS B) the majority of functional return is within the zone of partial preservation, and may be sufficient to reclassify the injury level to a lower spinal level. The vast majority of recovery occurs in the first 3 months, but a small amount can persist for up to18 months or longer. Some sensory recovery occurs after SCI, on roughly the same time course as motor recovery. Based on previous data of the magnitude of spontaneous recovery after SCI, as measured by changes in ASIA motor scores, power calculations suggest that the number of subjects required to achieve a significant result from a trial declines considerably as the start of the study is delayed after SCI. Trials of treatments that are most efficacious when given soon after injury will therefore, require larger patient numbers than trials of treatments that are effective at later time points. As AIS B patients show greater spontaneous recovery than AIS A patients, the number of AIS A patients requiring to be enrolled into a trial is lower. This factor will have to be balanced against the possibility that some treatments will be more effective in incomplete patients. Trials involving motor incomplete SCI patients, or trials where an accurate assessment of AIS grade cannot be made before the start of the trial, will require large subject numbers and/or better objective assessment methods.

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Section: Sources Of Datamentioning

confidence: 99%

Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP panel: spontaneous recovery after spinal cord injury and statistical power needed for therapeutic clinical trials

et al. 2006

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“…1 The consequences of the injury are reflected in the extent of loss of motor and sensory function and the resulting inability to perform activities of daily living (ADL). 2 For an individual with a SCI affecting the cervical level even the most basic ADL tasks becomes a challenge.…”

Section: Introductionmentioning

confidence: 99%

“…It can render the individual dependent upon assistance in many areas of daily living. 1,3 Important prerequisites for ADL are upper extremity function 4,5 and physical capacity. 6 Other important factors are age, gender, body mass, 7 physical fitness, 7,8 motivation, psychosocial status, medical complications 8 and sociocultural background.…”

Section: Introductionmentioning

confidence: 99%

Activity performance and upper extremity function in cervical spinal cord injury patients according to the Klein–Bell ADL Scale

Dahlgren

Lundgren‐Nilsson

et al. 2006

Spinal Cord

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“…10 It is estimated that 95% of ASIA D patients will be community ambulating at two years from the injury. 1,3,12 To be considered as a community ambulator, a patient should be able to use his gait as his primary means of mobility (Consortium for Spinal Cord Medicine). Speed and endurance though are crucial to further define community ambulating.…”

Section: Discussionmentioning

confidence: 99%

“…Depending on the type of injury and rehabilitation program most patients can recover some degree of gait capability. [1][2][3] In recent years many studies have focused on the design of gait improvement programs for this patient population. 4 Some of these training strategies include partial weight support on a treadmill, driven gait orthosis (Lokomat), ambulatory therapy, functional electrical stimulation (FES) or conventional indoor techniques.…”

Section: Introductionmentioning

confidence: 99%

Comparison of gait performance on different environmental settings for patients with chronic spinal cord injury

et al. 2007

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Study design: Observational cross-section study. Objectives: The objective of our study was to determine if the influence of a community environment would impact on ASIA D spinal cord injured (SCI) gait performance patients. Our main hypothesis is that an outdoor community environment may influence gait speed and endurance on community ambulating patients. Methods: Ten-Meter Walking (10MWT) and Six-Minute Walking (6MWT) tests were performed on community ambulating SCI research participants (n ¼ 18) in two different environmental conditions: (1) Experimental (indoors Gymnasium) and (2) Natural (community setting). Average gait speed and endurance values were obtained for the two different conditions and analyzed for statistical significance on the nonparametric two-tailed Wilcoxon signed rank test. Results: While no difference was observed on the 10MWT we found an improvement on gait performance on the 6 MWT on a community setting. Conclusions: Our study showed mixed results on environmental influence on gait speed and endurance on ASIA D patient population. While there is no difference on the 10 MWT, there is an improvement on gait performance on the communitary 6MWT.

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Motor and sensory recovery following incomplete tetraplegia

Cited by 366 publications

References 4 publications

Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP panel: spontaneous recovery after spinal cord injury and statistical power needed for therapeutic clinical trials

Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP panel: spontaneous recovery after spinal cord injury and statistical power needed for therapeutic clinical trials

Activity performance and upper extremity function in cervical spinal cord injury patients according to the Klein–Bell ADL Scale

Comparison of gait performance on different environmental settings for patients with chronic spinal cord injury

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