Impact of spasticity on functioning in spinal cord injury: an application of graphical modelling

Abstract

Spasticity is one of the most common complications of spinal cord injury. It influences limitations in functioning. Comprehensive evidence on the impact of spasticity on all domains of functioning may be beneficial to optimize rehabilitation interventions aimed at reducing the effects of spasticity. This is the first application of graphical modelling to study and visualize the impact of moderateto-severe spasticity on functioning in people living with spinal cord injury. The results show that chronic pain, contractures, tiredness, doing housework, and respiratory functions were the functioning domains associated with spasticity. These are therefore the top 5 potential targets for interventions to improve the experience of spasticity. In addition, the level and completeness of lesions should be considered when studying spasticity in relation to all domains of functioning. These results should be used as a basis for studies aiming to optimize rehabilitation interventions in people with moderate-to-severe spasticity. Objective: To identify the impact of moderate-to-severe spasticity on functioning in people living with spinal cord injury. Design: Secondary analysis of cross-sectional survey data using graphical modelling. Subjects: Individuals (n = 1,436) with spinal cord injury aged over 16 years with reported spasticity problems. Methods: Spasticity and 13 other impairments in body functions were assessed using the spinal cord injury Secondary Conditions Scale. Impairments in mental functions were assessed using the Mental Health subscale of the 36-item Short Form (SF-36). Independence in activities was measured with the Spinal Cord Injury Independence Measure Self-Report. Restrictions in participation were measured with the Utrecht Scale for Evaluation Rehabilitation-Participation. Results: Fifty-one percent of participants reported moderate-to-severe spasticity. Graphical modelling showed that Chronic pain, Contractures, Tiredness, Doing housework, and Respiratory functions were associated with spasticity and were the top 5 potential targets for interventions to improve the experience of spasticity. The associations and intervention targets were dependent on the level and completeness of the lesion. Conclusion: This is the first application of graphical modelling in studying spasticity in people living with spinal cord injury. The results can be used as a basis for studies aiming to optimize rehabilitation interventions in people with moderate-to-severe spasticity.

Revisiting functioning recovery in persons with spinal cord injury undergoing first rehabilitation: Trajectory and network analysis of a Swiss cohort study

“…Similar approaches have been described by Strobl et al [30] in early postacute rehabilitation but not specific to the SCI population. Kalisch et al [48], Reinhardt et al [49], and Ehrmann et al [50][51][52] have examined functioning association structures in persons with SCI in either the community or mixed settings (early post-acute and long-term situation) in Switzerland or other countries. However, the comparability of our findings with the results of other studies is limited because different studies often use a different variable set for network analysis.…”

Mixed-Variable Graphical Modeling for Medical Record-Based Predictive Models: Learning Pressure Injury Onset in Spinal Cord Injury Individuals

“…GM has been used to represent SCI body processes and functions in an organized, compact, and abstract way. GM identifies essential conditional independences and eliminates spurious relationships among variables extracted from social and medical data [26][27][28] . Despite claims of high problem prevalence and connectivity in each SCI functioning domain using GM, the methodologies used mainly involve undirected graphical modeling.…”

Recent progress and challenges in the treatment of spinal cord injury

“…( Ashammakhi et al, 2019 ). SCI interrupts the neural connections between the upper center and the spinal cord, leading to devastating and permanent neurological impairment, including sensory and motor disability, abnormal reflexes, and autonomic disorders ( Ehrmann et al, 2020 ; Ong et al, 2020 ). SCI not only seriously affects the quality of life and life span of patients, but it also leads to psychological and emotional disorders and social phobia, with enormous impact and heavy economic burden on the family as well as the social health care system ( Alizadeh et al, 2019 ).…”