Predicting neurologic recovery in traumatic cervical spinal cord injury

Kirshblum, Steven; O’Connor, Kevin

doi:10.1016/s0003-9993(98)90244-1

Cited by 164 publications

(129 citation statements)

References 91 publications

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“…Most of this change was due to gains in the lower extremity, consistent with IE therapy content. Motor gains were seen in 71% of IE subjects, which compares favorably with the natural history of chronic SCI, 22 where one study reported that 40% of subjects with SCI have show motor improvement over a 5-year period, though no information was available regarding therapy during that study. Importantly, in approximately one-third of subjects in the current IE group, motor gains included having at least one muscle change from non-functional to functional.…”

Section: Discussionmentioning

confidence: 92%

Effects of intense exercise in chronic spinal cord injury

2008

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Background: Exercise has beneficial effects on muscle and motor function after spinal cord injury (SCI). Little is known regarding effects of prolonged intense exercise (IE) in humans with chronic SCI. Design: Prospective, non-randomized, controlled observational study. The intervention was either a multimodal IE program (n ¼ 21) or a control (CTL) intervention consisting of self-regulated exercise (n ¼ 8).Objective: Measure sensorimotor function over 6 months in relation to an IE program. Setting: Single outpatient center. Subjects: Subjects with chronic SCI (n ¼ 29 total), mainly ASIA Impairment Scale A and B, injury levels C4-T11. Results: Baseline neurological assessments (for example, ASIA motor score, 39±3 vs 42±5, IE vs CTL, P40.5, mean ± s.e.m.) did not differ between the two groups. During the 6 months, IE subjects averaged 7.3±0.7 h per week exercise, not significantly different from CTL subjects (5.2±1.3 h per week, P40.1). However, after 6 months, IE subjects showed significantly greater motor gains than CTL subjects in the main outcome measure, ASIA motor score (change of 4.8 ± 1.0 vs À0.1 ± 0.5 points, P ¼ 0.0001). The main outcome measure was calculated by ASIA motor score. These IE subject ASIA motor gains correlated with number of exercise hours per week (r ¼ 0.53, Po0.02), and with type of specific IE components, particularly load bearing. Conclusions: Multimodal IE can significantly improve motor function in subjects with chronic SCI. An organized program may provide greater motor benefits than a self-regulated program; load bearing might be of particular value. IE might have therapeutic value in chronic SCI, and as an adjunct to other restorative therapies.

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Section: Discussionmentioning

confidence: 92%

Effects of intense exercise in chronic spinal cord injury

2008

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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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“…The origins of this test date back a number of decades. 4,5 Slight variants of this test have served as the primary outcome measure of neurologic status in a number of multi-center studies of drug treatment strategies to minimize secondary injury after acute SCI. 6,7 Like its predecessors, the ASIA scale includes testing of a number of muscles in both upper and lower-limbs.…”

Section: Introductionmentioning

confidence: 99%

Abductor hallucis for monitoring lower-limb recovery after spinal cord injury in man

2004

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Study design: Electromyogram (EMG) study on patients with acute spinal cord injury (SCI). Objectives: We hypothesized that subjects with mild to moderate acute SCI would have a higher probability of recovering function in intrinsic muscles of the foot compared to more proximal lower-limb muscles, based on the relative density of corticospinal tract innervation to these different motoneuron pools. Setting: Miami and Syracuse, USA. Methods: We conducted repeated measures of EMG during voluntary contractions from lower-limb muscles in subjects with acute traumatic SCI. For this study, analysis was restricted to those subjects who had either no recruitment (ie 'motor-complete') or limited recruitment (ie 'motor-incomplete') in any lower-limb muscle of either leg during the initial evaluation, and all of whom had converted to a motor-incomplete status in one or both legs at the time of final evaluation. Recruitment of the abductor hallucis (AbH) muscle during contraction attempts was judged as being either 'present' or 'absent', based upon the presence or absence of EMG-based volitional motor unit recruitment. Results: A total of 70 subjects were included in this study. Of these, 58 had motor-incomplete injury at or rostral to the T10 vertebral level, and another 12 had injury caudal to T10. In the former group, the AbH muscle showed a recovery probability that was considerably higher than that of other lower-limb muscles. Quite the opposite pattern was seen in persons with injury caudal to T10. In these subjects, recruitment was more common in proximal muscles of the thigh (psoas and quadriceps), and least common in the AbH muscle. Discussion: For persons with SCI at or rostral to the T10 vertebral level, the AbH muscle proved to be an earlier and more sensitive indicator of lower-limb contraction recovery following acute SCI compared to other lower-limb muscles. Including this intrinsic muscle of the foot as part of a neurologic assessment of muscle function after SCI should increase the test's sensitivity to preserved (or restored) supraspinal motor influence over lower-limb motoneuron pools, and is recommended.

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Predicting neurologic recovery in traumatic cervical spinal cord injury

Cited by 164 publications

References 91 publications

Effects of intense exercise in chronic spinal cord injury

Effects of intense exercise in chronic spinal cord injury

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

Abductor hallucis for monitoring lower-limb recovery after spinal cord injury in man

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