Towards improved clinical and physiological assessments of recovery in spinal cord injury: a clinical initiative

Abstract

Clinical practice and scientific research may soon lead to treatments designed to repair spinal cord injury. Repair is likely to be partial in the first trials, extending only one or two segments below the original injury. Furthermore, treatments that are becoming available are likely to be applied to the thoracic spinal cord to minimise loss of function resulting from damage to surviving connections. These provisos have prompted research into the improvement of clinical and physiological tests designed (1) to determine the level and density of a spinal cord injury, (2) to provide reliable monitoring of recovery over one or two spinal cord segments, and (3) to provide indices of function provided by thoracic spinal root innervation, presently largely ignored in assessment of spinal cord injury. This article reviews progress of the Clinical Initiative, sponsored by the International Spinal Research Trust, to advance the clinical and physiological tests of sensory, motor and autonomic function needed to achieve these aims.

Orthostatic hypotension following spinal cord injury: understanding clinical pathophysiology

“…18 Furthermore, the importance of the assessment of autonomic control following SCI was highlighted in a recent review article. 55 Altered baroreflex function Baroreceptors are stretch receptors located in the aortic arch, carotid sinus and coronary arteries that respond to perturbations in arterial pressure and reflexly modulate sympathetic and parasympathetic outflow in order to maintain blood pressure homeostasis. Dysfunctional baroreceptor reflex control may present with various clinical conditions, depending on the nature of the disorder.…”

Sensitivity to change of the cutaneous electrical perceptual threshold test in longitudinal monitoring of spinal cord injury

“…4 We did test in three fixed dermatomes (C4, T8 and L4) as well, targeting T C4 C4 1 1 C5 C5 D 2 M 24 5 12 17 T C4 C4 2 1 C6 C5 D 3 M 41 21 18 39 T C8 C8 0 0 C8 C8 C 4 M 60 8 17 25 NT T12 T12 0 0 T12 T12 D 5 M 64 2 16 18 T C1 C1 0 0 C1 C1 D 6 M 73 8 17 25 T C3 C3 À1 À2 C2 C1 D dermatomes well above and well below the injury level, but due to a mix of patients with very different levels of injury (between C1 and T12), we did not have enough cases for dermatomes C4 and T8 for statistical analysis, and in the dermatome L4 the pre-set upper stimulus intensity limit of 10 mA did not always yield a result. Therefore, the discussion concentrates mainly on the three dermatomes around the sensory level of injury.…”

“…[1][2][3] The need for improved and more sensitive outcome measures for SCI clinical trials has been emphasized repeatedly. [4][5][6][7] This is especially true of therapeutic clinical trials that, for safety reasons, may target patients with thoracic lesion, where current clinical assessment tools are not sensitive enough to detect minor neurological changes. The EPT test was developed with this in mind.…”

The Sir Ludwig Guttmann Lecture 2012: the contribution of Stoke Mandeville Hospital to spinal cord injuries

“…Since then we have contributed to the validation of the International Standards for Neurological Classification of Spinal Cord injury 52 and development of some new, more precise methods of quantifying the level and density of spinal cord lesions, 53 as part of the International Spinal Research Trust (ISRT) funded studies of physiological [54][55][56] and clinical outcome measures. [57][58][59][60] AGEING AND SURVIVAL Together with the Northwest Regional Spinal Injuries Centre, Southport, UK, and in collaboration with Craig Hospital, Englewood, CO, USA, we have undertaken a longitudinal study on Ageing with SCI in order to provide information on health, functional ability and psychosocial wellbeing in persons with long-term spinal cord injury.…”