Evidence of subclinical brain influence in clinically complete spinal cord injury: discomplete SCI

Sherwood, Arthur M.; Dimitrijevič, Milan R.; McKay, William

doi:10.1016/0022-510x(92)90014-c

Cited by 196 publications

(154 citation statements)

References 21 publications

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“…Samdani et al 13 reported that 40% of subjects who underwent the ISNCSCI examinations had no S4/5 sensation but did respond positively to deep anal pressure: concluding the importance of testing anal sensation to determine the American Spinal Injury Association Impairment Scale classification. However, studies [22][23][24] have indicated the possibility that anal pressure is perceived by patients through an alternative pathway, which is not indicative of spinal cord integrity. With the validity of the test for anal pressure in question and the extent of poor reliability at the S4/5 dermatomes, misclassification of completeness is a modest possibility.…”

Section: Discussionmentioning

confidence: 99%

Agreement of repeated motor and sensory scores at individual myotomes and dermatomes in young persons with spinal cord injury

et al. 2012

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Study design: A prospective repeated measures multicenter study to determine reliability at individual spinal levels when applied to young persons with spinal cord injury (SCI). Objectives: To evaluate intra-and inter-rater agreement of repeated motor and sensory scores at individual spinal levels. Setting: Shriners Hospitals for Children-Philadelphia and Chicago, USA Methods: A total 189 youth with complete and incomplete SCI underwent four neurological exams by two different raters. Agreement between and within raters for each myotome and dermatome was evaluated for complete and incomplete SCI separately. Intraclass correlation coefficients and 95% confidence intervals were calculated. Results: Overall, both intra-and inter-rater agreement resulted in moderate-to-high agreement among myotomes. Subjects with complete SCI had moderate agreement for light touch (LT) and pin prick (PP) testing, whereas subjects with incomplete SCI had 460.0% of dermatomes resulting in poor agreement for PP testing. Conclusion: Overall, moderate-to-high agreement was found for muscle strength comparisons and moderate-to-poor agreement was found for PP and LT.

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Section: Discussionmentioning

confidence: 99%

Agreement of repeated motor and sensory scores at individual myotomes and dermatomes in young persons with spinal cord injury

et al. 2012

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“…These recording are compared with patterns recorded from neurologically intact control subjects. BMCA has been used to demonstrate the ability to modify EMG reflex excitability in many persons clinically classified as complete SCI [49]. Applications include documentation of treatment effects for returning motor control [50], assessment of spasticity and cocontraction [51], and provision of objective criteria for the selection of intervention strategies [52].…”

Section: Motor Activity Measuresmentioning

confidence: 99%

Activity and participation after spinal cord injury: State-of-the-art report

Ullrich¹,

Spungen²,

Atkinson³

et al. 2012

JRRD

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Abstract-The importance of activities and community participation for persons with spinal cord injury (SCI) has been recognized for decades and yet theoretical and empirical advances have been limited. This report summarizes the recommendations for researchers on the topic of measuring activity and participation among persons with SCI formulated by the Spinal Cord Injury workgroup at the State-of-the-Art Conference on Outcome Measures in Rehabilitation held in January 2010. Activity and participation were defined as independent constructs ideally measured in reference to personal values and environmental influences. Measures of activity, participation, and factors influencing activity and participation are reviewed and critiqued. Gaps in available measures are described, measures in development are discussed, and suggestions for future research are made.

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“…However, lesions clinically judged as complete often retain residual supraspinal connectivity not clinically recognizable. 1,2 For motor incomplete spinal cord injured (iSCI) subjects, partially disrupted voluntary control of lower-limb muscles determines many aspects of their recovery following the acute phase post injury.…”

Section: Introductionmentioning

confidence: 99%

“…17,18 One such objective measure of residual motor function is found in the Brain Motor Control Assessment (BMCA) protocol that couples standardized administration and control of instructions, environment, and pace of presentation of elementary voluntary motor tasks with the recording of multi-muscle sEMG. 1,[19][20][21][22] The BMCA protocol has demonstrated consistency and sensitivity to subclinical motor function. 1,2 Fung and Barbeau 23 found that by applying a 'dynamic EMG profile index' to the repeating cycles of muscle activation they could characterize gait.…”

Section: Introductionmentioning

confidence: 99%

Neurophysiological assessment of lower-limb voluntary control in incomplete spinal cord injury

et al. 2005

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Study design: Cross-sectional retrospective study of a neurophysiological method of voluntary motor control characterization. Objectives: This study was undertaken to validate the surface electromyography (sEMG)-based voluntary response index (VRI) as an objective, quantitative, laboratory measure of spinal cord injury severity in terms of voluntary motor control disruption. Setting: VA Medical Centers in Houston and Dallas Texas, USA. Methods: A total of 67 subjects with incomplete spinal cord injury (iSCI), American Spinal Injury Association Impairment Scale (AIS)-C (n ¼ 32) and -D (n ¼ 35) were studied. sEMG recorded during a standardized protocol including eight lower-limb voluntary motor tasks was analyzed using the VRI method that relates multi-muscle activation patterns of SCI persons to those of healthy-subject prototypes (n ¼ 15). The VRI is composed of a measure of the amount of the sEMG activity (magnitude) and the distribution of activity across muscle groups compared to that of healthy subjects for each motor task (similarity index, SI). These resulting VRI components, normalized magnitude and SI, were compared to AIS clinical findings in this study. Receiver operating characteristic analysis was performed to determine the SI values best separating AIS-C and AIS-D subjects. Results: Magnitude and SI for AIS-C subjects had mean values of 0.2770.32 and 0.6570.21, respectively. Both parameters were significantly larger in the AIS-D subjects (0.7870.43 and 0.9370.06), respectively (Po0.01). An SI value of 0.85 was found to separate AIS-C and AIS-D groups with a sensitivity of 0.89 and a specificity of 0.81. Further, the VRI of each leg strongly correlated with the respective AIS motor score (0.80, ro0.01). Conclusions: In the domains of voluntary motor control, the sEMG-based VRI demonstrated adequate face validity and sensitivity to injury severity as currently measured by the AIS.

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Evidence of subclinical brain influence in clinically complete spinal cord injury: discomplete SCI

Cited by 196 publications

References 21 publications

Agreement of repeated motor and sensory scores at individual myotomes and dermatomes in young persons with spinal cord injury

Agreement of repeated motor and sensory scores at individual myotomes and dermatomes in young persons with spinal cord injury

Activity and participation after spinal cord injury: State-of-the-art report

Neurophysiological assessment of lower-limb voluntary control in incomplete spinal cord injury

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