Prediction of functional outcome by motor capability after spinal cord injury

The relationship between early motor status and functional outcome after spinal cord injury (SCI) was evaluated prospectively in 52 quadriplegic and 26 paraplegic patients. Motor status was measured within 72 hours of injury and quantified with the Motor Index Score (MIS). Functional status was evaluated with the Modified Barthel Index (MBI). A senior physical therapist completed the MIS and the MBI when each patient was admitted to the spinal cord intensive care unit and every 30 days during rehabilitation. Early motor function was correlated with average daily improvement in functional status including self-care and mobility (p = .001). The initial MIS strongly correlated with functional status of quadriplegics at admission (p = .001), at 60 days, and at rehabilitation discharge (p = .001). In paraplegics, the overall MBI at admission, after 60 days of rehabilitation, and at discharge was not correlated with early motor function. However, the MIS correlated significantly with the MBI self-care subscore at 60 days and at discharge (p = .01), but not with the mobility subscore. The initial MIS was also significantly correlated to functional status at discharge in patients with complete lesions (p = .001), but was not related to functional status at discharge in patients with incomplete lesions. The MIS appears to be a useful tool in predicting function during rehabilitation, although individual differences in ambulation, particularly for patients with paraplegia, limit the predictive utility of this index.     

Functional improvement after pediatric spinal cord injury

OBJECTIVE: To describe the functional gain (FGain) with pediatric spinal cord injury inpatient rehabilitation and to identify the relationship of various factors to FGain in pediatric spinal cord injury inpatient rehabilitation. DESIGN: Retrospective chart review of a series of 91 children with spinal cord injury admitted from 1993 to 1998 in a freestanding rehabilitation hospital. Admission and discharge functional status were assessed with the Pediatric Functional Independence Measure (WeeFIM) instrument for children 7 yr. The outcome measure is the FGain (difference between the discharge and admission functional status). RESULTS: Significant gains in functional status were observed in all patients. FGain was not significantly related to age, sex, length of inpatient rehabilitation, pathogenesis, or completeness or neurologic level of injury. However, there was a trend for higher FGain for patients with incomplete spinal cord injury and traumatic spinal cord injury. CONCLUSIONS: Functional improvement occurs with pediatric spinal cord injury inpatient rehabilitation. There is a trend for higher FGain in patients with less severe injury and traumatic injury. The lack of relationship between FGain and length of inpatient rehabilitation suggests that a variety of other factors influence the relationship between FGain and length of inpatient rehabilitation.     

Vector-mediated expression of erythropoietin improves functional outcome after cervical spinal cord contusion injury

We evaluated the therapeutic effect of erythropoietin (EPO) delivered by direct injection of a nonreplicating herpes simplex virus (HSV)-based vector coding for EPO (vEPO) in a model of cervical hemicord contusion at C7. At 1?h after spinal cord injury (SCI), either vEPO or control vector carrying a reporter gene (vC) was injected into the cord above and below the lesion. Animals injected with vEPO showed a statistically significant improvement in the ipsilateral forelimb function, as measured by open-field evaluation of motor performance, forelimb reaching in the cylinder test and misplacement in grid walk. This correlated with preservation of gray matter in the area of the lesion. There was also mild but significant improvement of hindlimb motor function measured by Basso-Beattie-Bresnahan score and computerized gait analysis in vEPO compared with control vector-injected animals. Microtubule-associated protein tau, phosphorylated and nonphosphorylated neurofilament protein and the synaptic proteins synaptophysin and PSD-95 were all significantly increased in the spinal cord of vEPO-treated animals compared with control vector-injected animals. These data suggest that gene transfer of EPO after cervical SCI by minimizing the injury size and enhancing tissue sparing preserves large-caliber axons and promotes synaptogenesis.     

Course of functional improvement after stroke, spinal cord injury, and traumatic brain injury.

OBJECTIVE: To examine functional improvement patterns of persons with stroke, traumatic brain injury (TBI), and spinal cord injury (SCI). DESIGN: Statistical analysis of data from a multisite study evaluating rehabilitation outcomes. SETTING: Eight inpatient rehabilitation facilities. PARTICIPANTS: A total of 314 consecutive admissions of persons with stroke, SCI, and TBI who received acute medical rehabilitation between 1994 and 1998. INTERVENTION: Calibration of motor and cognitive items from the FIM instrument, grouping of cases by number of weeks of rehabilitation (length of stay [LOS] groups), and plotting of weekly averages across time. MAIN OUTCOME MEASURES: Weekly motor and cognitive functional status. RESULTS: With the exception of cognitive functioning for persons with SCI, LOS was related to initial functional status, with patients with greater disability having longer LOS (eg, initial motor status for persons with stroke was 48.3 for those with a 2-week stay, 36.8 for a 6-week stay, with the averages between decreasing monotonically). With the exception of cognitive gains for person with TBIs, the amount of functional gain during rehabilitation was essentially the same for all LOS groups (eg, the overall average total motor gain for persons with SCI is 22.3, with no patterns of increase or decrease across LOS groups); however, the rate of improvement in motor (but not cognitive) functioning differed across LOS groups, with patients with shorter stays having the greater rates of improvement (eg, the overall average weekly motor gain for persons with SCI was 3.6, with the averages by LOS group monotonically decreasing from 6.4 for those with 4-week stays to 2.7 for those with 9-week stays). CONCLUSIONS: When examined separately for persons grouped by LOS, functional status improved linearly during the rehabilitation stay, with differences in rate of improvement depending on initial functional status.     

运动训练对脊髓损伤大鼠运动及神经功能恢复的影响

目的探讨不同运动训练时程对大鼠脊髓损伤后运动、神经功能恢复的影响。 方法Sprague Dawley大鼠95只,分为模型组（未给予运动训练）、实验组（根据训练时程分为训练1周、2周、3周、4周组）和假手术组（切除椎板暴露脊髓,但不造成脊髓损伤）。采用改良Allen撞击法制作胸髓（T10）不完全损伤模型。运动方式采用重量支撑平板步行训练,在不同时间点采用斜板试验、改良Tarlov评分、Basso Beattie Bresnahan（BBB）评分、脊髓体感诱发电位进行运动及神经功能评定。 结果①运动功能：大鼠运动训练1,2,3和4周后,运动功能均较模型组有明显提高（P<0.05）;②脊髓体感诱发电位：大鼠运动训练2,3和4周后,N1波峰潜伏期较模型组显著缩短（P<0.05）,且随训练时程增加而逐步缩短（P<0.05）。 结论部分重量支撑平板步行训练能有效改善不完全性脊髓损伤大鼠运动及神经功能,并且其改善作用与运动训练时程相关。     

Neuroanatomical substrates of functional recovery after experimental spinal cord injury: implications of basic science research for human spinal cord injury

Human spinal cord injury (SCI) is a devastating condition that results in persistent motor deficits. Considerable basic and clinical research is directed at attenuating these deficits. Many basic scientists use animal models of SCI to (1) characterize lesion development, (2) determine the role of spared axons in recovery, and (3) develop therapeutic interventions based on these findings. In this article, current research is reviewed that indicates: (1) most individuals with SCI will have some sparing of white matter at the lesion epicenter even when the lesion appears clinically complete, (2) even minimal tissue sparing has a profound impact on segmental systems and recovery of function, and (3) facilitatory intervention such as weight bearing and locomotor training after SCI may be more effective than compensatory strategies at inducing neuroplasticity and motor recovery. Body weight supported treadmill step training is discussed as an example of new facilitatory interventions based on basic science research using animal models.     

Assessment of measures for abdominal adiposity in persons with spinal cord injury

Ultrasound may be a useful tool to assess abdominal adiposity, but it has not been validated in the spinal cord injury (SCI) population. This study evaluated associations between abdominal ultrasound and other methods to assess adiposity in 24 men with SCI and 20 able-bodied (AB) men. Waist (WC) and hip circumference (HC) and waist-to-hip ratio (WHR) were measured. Trunk (TRK%), android (A%) and waist fat (W%) were determined by dual energy x-ray absorptiometry (DXA); ultrasonography determined abdominal subcutaneous (SF) and visceral fat (VF). The SCI group had greater TRK% (40.0 ± 9.6 vs. 32.0 ± 10.3), W% (47.0 ± 9.7 vs. 40.6 ± 9.4), A% (43.0 ± 9.8 vs. 35.8 ± 10.6) and WHR (0.99 ± 0.1 vs. 0.92 ± 0.06) than the AB group. WC and WHR correlated with VF in the SCI group. These associations suggest that ultrasound may be a useful tool in clinical practice for the measurement of VF in weight loss programs and for the assessment of cardiometabolic disorders.(E-mail: racine.emmons@va.gov)     

Altered heart rate variability and pulse-wave velocity after spinal cord injury

BACKGROUNDHeart rate variability (HRV) and pulse-wave velocity (PWV), indicators of cardiac function, are altered in patients with spinal cord injury (SCI), suggesting that autonomic cardiac function and arterial stiffness may underlie the high risk of cardiovascular complications in these patients. No study has simultaneously investigated HRV and PWV in the same patients.AIMTo evaluate cardiovascular complications in SCI patients by comparing HRV and PWV between patients with and without SCI.METHODSIn this cross-sectional pilot study, patients with (n = 60) and without SCI (n = 60) were recruited from December 7, 2019 to January 21, 2020. Each participant received a five-minute assessment of HRV and the cardiovascular system using the Medicore HRV Analyzer SA-3000P. Differences in HRV and PWV parameters between participants with and without SCI were statistically examined.RESULTSWe observed a significant difference between participants with and without SCI with respect to the standard deviation of all normal-to-normal intervals, square root of the mean sum of squared successive risk ratio interval differences, physical stress index, total power, very-low frequency, low frequency, high frequency, and arterial elasticity.CONCLUSIONPatients with SCI have weaker sympathetic and parasympathetic activity as well as lower arterial elasticity compared to those without, suggesting that SCI may increase cardiac function loading.     

Gsx1 promotes locomotor functional recovery after spinal cord injury

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N-benzyloxycarbonyl-Val-Ala-Asp-fluoromethylketone reduces severity of experimental spinal cord injury

The aim of this study was to investigate the effects of N-benzyloxycarbonyl-Val-Ala-Asp-fluoromethylketones (z-VAD-fmk) on the degree of experimental spinal cord trauma induced by the application of vascular clips (force of 24 g) to the dura via a four-level T5-T8 laminectomy. Spinal cord injury in mice resulted in severe trauma characterized by edema, neutrophil infiltration, production of a range of inflammatory mediators, tissue damage, and apoptosis. Treatment of the mice with z-VAD-fmk, a potent broad specific caspase inhibitor, significantly reduced the degree of (1) spinal cord inflammation and tissue injury (histological score), (2) neutrophil infiltration (myeloperoxidase activity), (3) nitrotyrosine formation, and (4) apoptosis (TUNEL staining and Bax and Bcl-2 expression). In a separate set of experiments, z-VAD-fmk significantly ameliorated the recovery of limb function (evaluated by motor recovery score). Taken together, our results clearly demonstrate that treatment with z-VAD-fmk reduces the development of inflammation and tissue injury associated with spinal cord trauma.     

Glycyrrhizin reduces secondary inflammatory process after spinal cord compression injury in mice

Glycyrrhizin, a major active constituent of liquorice root (Glycyrrhiza glabra), has a free radical scavenging property, and its effects were evaluated on an animal model of spinal cord injury (SCI) induced by the application of vascular clips (force of 24 g) to the dura via a four-level T5-T8 laminectomy. Spinal cord injury in mice resulted in severe trauma characterized by edema, tissue damage, and apoptosis (measured by terminal deoxynucleotidyltransferase-mediated dUTP-biotin end labeling staining, Bax, and Bcl-2 expression). Immunohistochemical examination demonstrated a marked increase in immunoreactivity for nitrotyrosine, iNOS, and poly(adenosine diphosphate-ribose) in the spinal cord tissue. Additionally, we demonstrate that these inflammatory events were associated with the activation of nuclear factor-kappaB. In contrast, the degree of (1) spinal cord inflammation and tissue injury (histological score), (2) nitrotyrosine and poly(adenosine diphosphate [ADP] ribose) formation, (3) iNOS expression, (4) nuclear factor-kappaB activation, and (5) apoptosis (terminal deoxynucleotidyltransferase-mediated dUTP-biotin end labeling, Bax, and Bcl-2) was markedly reduced in spinal cord tissue obtained from mice treated with glycyrrhizin extract (10 mg/kg, i.p., 30 min before and 1 and 6 h after SCI). In a separate set of experiments, we have clearly demonstrated that glycyrrhizin extract treatment significantly ameliorated the recovery of limb function (evaluated by motor recovery score). Taken together, our results clearly demonstrate that treatment with glycyrrhizin extract reduces the development of inflammation and tissue injury events associated with spinal cord trauma.     

β-七叶皂甙钠抑制损伤脊髓细胞胶质纤维酸性蛋白的表达

背景：研究证实脊髓损伤后早期应用甲基强的松龙冲击治疗可以减轻脊髓损伤的病理程度,但是近20年未再有突破性进展。 目的：观察β-七叶皂甙钠对脊髓损伤大鼠脊髓神经细胞坏死及胶质纤维酸性蛋白抗体表达的影响。 方法：采用改良Allen撞击方法建立脊髓损伤大鼠模型,将建模成功的180只SD大鼠按照随机数字表法分成3组,每组60只,造模后即刻给药,β-七叶皂甙钠组腹腔注射5 mg/kgβ-七叶皂甙钠,甲基强的松龙组腹腔注射100 mg/kg甲基强的松龙,对照组腹腔注射等体积生理盐水。每天给药1次,于治疗后8,24,96 h,治疗后7,14 d 5个时间节点处死实验动物并取损伤段脊髓进行苏木精-伊红染色及免疫组化染色观察脊髓组织坏死神经细胞数及胶质纤维酸性蛋白抗体表达情况。 结果与结论：各组均于治疗后8 h出现坏死细胞且7 d达高峰,14 d时水肿减轻但坏死细胞并未减少,但β-七叶皂甙钠及甲基强的松龙两组同一时间点上坏死细胞数目均明显少于对照组（P〈0.05）;各组胶质纤维酸性蛋白吸光度均随着时间延长而增加,β-七叶皂甙钠组与对照组在96 h内增加快速,而甲基强的松龙组缓慢均匀增加,24 h以内β-七叶皂甙钠组与对照组之间无明显差别,但均低于甲基强的松龙组（P〈0.05）,96 h后β-七叶皂甙钠及甲基强的松龙两组均明显低于对照组（P〈0.05）,7 d后各组均开始缓慢下降。结果表明β-七叶皂甙钠对脊髓损伤大鼠脊髓细胞具有明显保护作用,可通过减少胶质纤维酸性蛋白的表达促进神经功能恢复,在用药2周时间内的效果与甲基强的松龙相似。     

Utilisation of patient perspective to validate clinical measures of outcome following spinal cord injury

Purpose. The purpose of this article is to utilise the perspective of persons with a spinal cord injury (SCI), gained from focus groups, to validate recommended clinical measures of outcome.

Method. Clinical measures of outcome as recommended by Wood-Dauphinee and the SCI Consensus Group were categorised using the World Health Organisation's International Classification of Functioning, Disability and Health (ICF). These were then cross-referenced to the problems of functioning identified by patients in 10 focus groups held in New Zealand as part of the International ICF Core Set project. The focus groups were performed separately for people in the post-acute situation and in the chronic situation to address different experiences since SCI.

Results. In the post-acute group, the recommended measures of functioning, the Functional Independence Measure (FIM), Hospital Anxiety and Depression Scale and Visual Analogue Scale for pain correlated well against the focus groups identification of problems of functioning. In the chronic group, the short-form Craig Handicap Assessment and Reporting Technique (sf-CHART), the SF-12 and the Life Satisfaction Questionnaire (LSQ) largely captured the problems of functioning identified. There were some categories that were common to both patient groups and were not changed by time since SCI. In addition, there were some problems of functioning identified by the patient groups that were not covered by the suggested measures.

Conclusions. Utilisation of a battery of outcome measures based on a theoretical framework can quantify problems of functioning in the SCI population. Although the measures suggested by SCI Consensus Group largely capture the problems of functioning, other outcome measures have been shown to be more responsive to the changes in the SCI population and also incorporate more of the identified problems of functioning.     

Assessment of sexual functions after spinal cord injury in Indian patients

This study assessed the interacting physical, psychological and social aspects of sexuality among 86 males and 14 females with spinal cord injury (SCI). Data collection involved the use of a 42-item study-specific questionnaire designed to determine different aspects of sexuality. Subjects were rated, after interview, on a scale according to an integrated index of sexual function (IISF). It was observed that patients scoring higher on this index were sexually more active and showed positive sexual adjustments. A higher incidence of complications of SCI, partner dissatisfaction, less partner co-operation, lower self-esteem and social taboos were factors responsible for less sexual activity in our patients. The present study suggests that there is a strong need for improved treatment of the medical complications of SCI, sexual counselling, literature, information and peer support in this country. We are of the opinion that the IISF can be utilized in rehabilitation settings to examine the interplay of the various complex factors in sexual rehabilitation post-SCI.     

Pain after spinal cord injury

Evaluation of pain in a person with SCI should commence with a determination of the neurologic level and the completeness of injury. The pain then can be localized to one of three regions: above level, at level, or below level. The regional pain then should be categorized either as nociceptive or neuropathic and, after this, subdivided into a specific subtype. An evidence based treatment plan can be devised depending on the specific subtype, which may include physical measures, pharmacologic treatments, behavioral interventions, surgery, or an eclectic combination program. The treatment plan usually can provide some relief for any of the subtypes, although complete relief often is not possible.     

脊髓损伤后疼痛

各种文献所报道的脊髓损伤 (ｓｐｉｎａｌｃｏｒｄｉｎｊｕｒｙ ,ＳＣＩ)后疼痛的发生率差异很大 ,有报道称发生率为5 %— 70 % [1] ,也有报道认为 ,ＳＣＩ后疼痛很常见 ,其发生率一般可达到 6 5 % ,其中大约有 1/ 3属于严重疼痛[2 ] 。ＳＣＩ后疼痛会对患者的康复治疗以及日常活动造成不良影响 ,使其生活质量降低[3、4 ] 。但目前对ＳＣＩ后疼痛仍然缺乏有效的治疗措施 ,因此 ,有必要进行深入的研究。1影响ＳＣＩ后疼痛的因素在可能影响ＳＣＩ后疼痛的各种因素中[5、6 ] ,对损伤性质 (完全性或不完全性 )、损伤平面、心理状况等因素的研究…     

Employment after spinal cord injury

A predictive model for employment after spinal cord injury was developed. The study population consisted of 154 spinal cord injured persons who were treated at our hospital between 1973 and 1979, and followed for seven years after injury. Demographic, social, and injury severity data were abstracted from each subject's hospital record. Motivation to work, employment history, and sources of postinjury financial support, were assessed by a vocational rehabilitation counselor. The study population was divided into four groups: persons continuously unemployed after injury, homemakers, students, and those employed at some time during the seven-year follow-up period. Stepwise discriminant analysis was used to develop a predictive model that ultimately included seven variables: gender, motivation to work, whether the patient's last job required ambulation, race, educational level, a functional ability score, and whether the patient had children. The model correctly classified 82% of those persons who were continuously unemployed, 100% of homemakers, 63% of students, and 72% of employed subjects. Overall, 79% of subjects were classified correctly. The most important classification errors were between the unemployed and employed groups. Seventeen percent of employed patients were incorrectly classified as unemployed, and 11% of unemployed patients were incorrectly classified as employed. Although there are other determinants of postinjury vocational status, individual potential can be assessed by means of a comparatively small set of predictor variables.     

Burns after spinal cord injury

The problem of burns after spinal cord injury is described. Chart review was performed on thirty-five known cases. All burns occurred below the level of the lesion (p less than .001). Causes included bathing and showering, food and beverage, and therapeutic and environmental heating devices. We conclude that spinal cord injured patients should be educated about the risk of burn injury and the situations in which burns can occur.