Relationship Between Motor Recovery and Independence After Sensorimotor-Complete Cervical Spinal Cord Injury

Kramer, John L.K.; Lammertse, Daniel P.; Schubert, Martin; Curt, Armin; Steeves, John D.

doi:10.1177/1545968312447306

Cited by 76 publications

(80 citation statements)

References 28 publications

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“…We found different error patterns (Figure 3) between myotomes on arms and legs compared to not in ISNCSCI examined myotomes in high cervical (C2-C4), thoracic (T2-L1) and low sacral (S2-S5) region. Please refer to Kramer et al 23 and Steeves et al 24 for further considerations and discussions regarding motor levels.…”

Section: Discussionmentioning

confidence: 99%

International standards for neurological classification of spinal cord injury: classification skills of clinicians versus computational algorithms

et al. 2014

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Study design: This is a retrospective analysis. Objectives: The objective of this study was to describe and quantify the discrepancy in the classification of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) by clinicians versus a validated computational algorithm. Settings: European Multicenter Study on Human Spinal Cord Injury (EMSCI).Methods: Fully documented ISNCSCI data sets from EMSCI's first years (2003)(2004)(2005) classified by clinicians (mostly spinal cord medicine residents, who received in-house ISNCSCI training by senior SCI physicians) were computationally reclassified. Any differences in the scoring of sensory and motor levels, American Spinal Injury Association Impairment Scale (AIS) or the zone of partial preservation (ZPP) were quantified. Results: Four hundred and twenty ISNCSCI data sets were evaluated. The lowest agreement was found in motor levels (right: 62.1%, P = 0.002; left: 61.8%, P = 0.003), followed by motor ZPP (right: 81.6%, P = 0.74; left 80.0%, P = 0.27) and then AIS (83.4%, P = 0.001). Sensory levels and sensory ZPP showed the best concordance (right sensory level: 90.8%, P = 0.66; left sensory level: 90.0%, P = 0.30; right sensory ZPP: 91.0%, P = 0.18; left sensory ZPP: 92.2%, P = 0.03).

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Section: Discussionmentioning

confidence: 99%

International standards for neurological classification of spinal cord injury: classification skills of clinicians versus computational algorithms

et al. 2014

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“…Thus, we often rely on comparisons against study end points statistically estimated from historical data sets tracking spontaneous recovery patterns after SCI. [1][2][3][4][5] However, there are a number of emerging neural protective, neural repair and neuroplasticity strategies, which require sensitive and accurate assessment for the reliable interpretation of their clinical importance. [6][7][8] Various outcome instruments, such as elements of the international standards for neurological classification of spinal cord injury (ISNCSCI), spinal cord independence measure (SCIM), the functional independence measure and short form 36 health survey, have been suggested as potential tools to measure aspects of recovery.…”

Section: Introduction To Outcome Measurements In Sci Clinical Trialsmentioning

confidence: 99%

“…[6][7][8] Various outcome instruments, such as elements of the international standards for neurological classification of spinal cord injury (ISNCSCI), spinal cord independence measure (SCIM), the functional independence measure and short form 36 health survey, have been suggested as potential tools to measure aspects of recovery. [2][3][4][9][10][11][12][13][14][15] Obviously, the data from such study valuations are dependent on the level and severity of SCI, the heterogeneity within each study cohort, the therapeutic target, the nature of the therapy, any confounding influences or comorbidities, the assessment times relative to the date of injury, the outcome measurement instrument and the clinical endpoint threshold used to assess any change in tissue activity, functional behaviour or quality of life (QoL).…”

Section: Introduction To Outcome Measurements In Sci Clinical Trialsmentioning

confidence: 99%

Challenges for defining minimal clinically important difference (MCID) after spinal cord injury

Liu

Tanadini

et al. 2014

Spinal Cord

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Study design: This is a review article. Objectives: This study discusses the following: (1) concepts and constraints for the determination of minimal clinically important difference (MCID), (2) the contrasts between MCID and minimal detectable difference (MDD), (3) MCID within the different domains of International Classification of Functioning, disability and health, (4) the roles of clinical investigators and clinical participants in defining MCID and (5) the implementation of MCID in acute versus chronic spinal cord injury (SCI) studies. Methods: The methods include narrative reviews of SCI outcomes, a 2-day meeting of the authors and statistical methods of analysis representing MDD. Results: The data from SCI study outcomes are dependent on many elements, including the following: the level and severity of SCI, the heterogeneity within each study cohort, the therapeutic target, the nature of the therapy, any confounding influences or comorbidities, the assessment times relative to the date of injury, the outcome measurement instrument and the clinical end-point threshold used to determine a treatment effect. Even if statistically significant differences can be established, this finding does not guarantee that the experimental therapeutic provides a person living with SCI an improved capacity for functional independence and/or an increased quality of life. The MDD statistical concept describes the smallest real change in the specified outcome, beyond measurement error, and it should not be confused with the minimum threshold for demonstrating a clinical benefit or MCID. Unfortunately, MCID and MDD are not uncomplicated estimations; nevertheless, any MCID should exceed the expected MDD plus any probable spontaneous recovery. Conclusion: Estimation of an MCID for SCI remains elusive. In the interim, if the target of a therapeutic is the injured spinal cord, it is most desirable that any improvement in neurological status be correlated with a functional (meaningful) benefit.

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“…Some work has been done to explore the relationship between ISNCSCI upper extremity motor scores (UEMS) to the self-care subscale of the SCIM, which identifies clinically meaningful change. [10][11][12] However, the presentation of upper limb recovery with more sensitive assessments, such as: the Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP) has not been presented to date.…”

Section: Introductionmentioning

confidence: 99%

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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Relationship Between Motor Recovery and Independence After Sensorimotor-Complete Cervical Spinal Cord Injury

Cited by 76 publications

References 28 publications

International standards for neurological classification of spinal cord injury: classification skills of clinicians versus computational algorithms

International standards for neurological classification of spinal cord injury: classification skills of clinicians versus computational algorithms

Challenges for defining minimal clinically important difference (MCID) after spinal cord injury

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

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