Optimizing the Management of Spasticity in People With Spinal Cord Damage: A Clinical Care Pathway for Assessment and Treatment Decision Making From the Ability Network,an International Initiative

The recognition, evaluation, and management of disabling spasticity in persons with spinal cord damage (SCD) is a challenge for health care professionals, institutions, health systems, and patients. To guide the assessment and management of disabling spasticity in individuals with SCD, the Ability Network, an international panel of clinical experts, developed a clinical care pathway. The aim of this pathway is to facilitate treatment decisions that take into account the effect of disabling spasticity on health status, individual preferences and treatment goals, tolerance for adverse events, and burden on caregivers. The pathway emphasizes a patient-centered, individualized approach and the need for interdisciplinary coordination of care, patient involvement in goal setting, and the use of assessment and outcome measures that lend themselves to practical application in the clinic. The clinical care pathway is intended for use by health care professionals who provide care for persons with SCD and disabling spasticity in various settings. Barriers to optimal spasticity management in these people are also discussed. There is an urgent need for the clinical community to clarify and overcome barriers (knowledge-based, organizational, health system) to optimizing the management of spasticity in people with SCD.     

Application of the Brixton Spatial Anticipation Test in Stroke: Ecological Validity and Performance Characteristics

Executive dysfunction predicts functional recovery post-stroke. However, traditional neuropsychological tests have limitations with this population due to required verbal response, complex motor response, and lengthy administration time. This study examined the ecological validity and performance characteristics of a relatively new measure of executive function, the Brixton Spatial Anticipation Test, which does not place the aforementioned demands on these patients. A total of 57 ischemic stroke patients with frontal lobe and subcortical lesions were administered the Brixton, on average 2 weeks post-stroke, during inpatient rehabilitation and assessed using the Functional Independence Measure (FIM) upon discharge. Brixton performance was significantly correlated with the FIM Total and FIM Cognitive Subtotal at discharge but unrelated to FIM Motor Subtotal. After controlling for global ability measured by the RBANS, Brixton performance accounted for additional variance in predicting FIM Total score at discharge. Interestingly, patients with subcortical strokes in the thalamus and basal ganglia performed significantly worse than patients with strokes in the frontal cortex on the Brixton, supporting the role of subcortical structures in the frontal lobe circuitry and executive function. Based on the present findings, the Brixton is a sensitive measure conducive to the stroke population and has strong ecological validity for identifying cognitive functional outcomes post-stroke.     

脊髓独立性评定及其第3版介绍

功能能力评定是脊髓损伤患者功能结局评定的主要项目之一。目前常用评定脊髓损伤患者功能能力的量表有Bar-thel指数、修订Barthel指数、功能独立性评定、脊髓独立性评定、脊髓损伤步行指数等。其中,脊髓独立性评定是为评价脊髓损伤患者的功能能力而专门设计的量表,已经过两次修订和国际多中心试验验证,具有良好的信度、效度和灵敏性,可适用于不同文化背景下的脊髓损伤患者的功能能力评定。但该评定方法也存在一定的局限性,需要进一步完善。     

神经干细胞移植治疗外伤性颅内血肿后遗症20例临床疗效分析

目的探讨应用神经干细胞移植治疗外伤性颅内血肿后遗症的临床疗效。方法对20例外伤性颅内血肿后遗症患者行腰椎穿刺蛛网膜下腔注入神经干细胞,并于第1次术前和第4次术后半年进行功能独立性评定（FIM）。结果患者自我料理、括约肌控制、活动和转移、运动、交流、社会认知都有明显改善（P〈0.01）。结论神经干细胞移植可以改善外伤性颅内血肿患者损伤的症状和体征,提高患者生活质量。     

Predictors of Change in Physical Function in Older Adults in Response to Long-Term,Structured Physical Activity: The LIFE Study

Objectives

To evaluate the extent of variability in functional responses in participants in the Lifestyle Interventions and Independence for Elders (LIFE) study and to identify the relative contributions of intervention adherence, physical activity, and demographic and health characteristics to this variability.

313例脊髓损伤患者FIM评定结果分析

目的探讨不同损伤平面、不同损伤程度的脊髓损伤(SCI)患者日常生活活动(ADL)状况的特点。方法对313例SCI住院患者进行功能独立性评定(FIM)评分,根据损伤平面和损伤程度的不同,将FIM评定的得分情况进行统计学分析。结果颈、胸、腰髓损伤患者的得分差异有显著性意义(P<0.05~0.01);随损伤平面的降低,FIM评分升高;同一损伤平面不同损伤程度的SCI患者的FIM评分差异有显著性意义(P<0.05~0.01),但腰髓完全性和不完全性SCI患者的FIM评分差异无显著性意义(P>0.05)。结论FIM评分可客观反映不同损伤平面、不同损伤程度SCI患者的ADL状况。     

Robot-assisted gait training might be beneficial for more severely affected children with cerebral palsy

Purpose: Robot-assisted gait training (RAGT) can complement conventional therapies in children with cerebral palsy. We investigated changes in walking-related outcomes between children with different Gross Motor Function Classification System (GMFCS) levels and the dose–response relationship. Methods: Data from 67 children (3.9–19.9 years) with GMFCS levels II–IV were evaluated retrospectively. Every child received RAGT with the Lokomat complementing a multidisciplinary rehabilitation program. Changes in various walking-related outcomes were assessed. Results: Walking-related outcomes did not improve differently between GMFCS level groups. Significant within-group improvements were mainly observed in children with GMFCS level IV. A dose–response relationship was present for children with GMFCS levels III and IV. Conclusions: Our results indicated that, although children with a GMFCS level IV walked less during an average Lokomat session, they experienced significant improvements in walking-related outcomes. Further, training dose correlated with changes in walking-related outcomes. However, between-group differences in changes in walking-related outcomes were not significant.