Prediction and Stratification of Upper Limb Function and Self-Care in Acute Cervical Spinal Cord Injury With the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP)

Velstra, Inge-Marie; Bolliger, Marc; Tanadini, Lorenzo G.; Baumberger, Michael; Abel, Rainer; Rietman, Johan Swanik; Curt, Armin

doi:10.1177/1545968314521695

Cited by 41 publications

(42 citation statements)

References 44 publications

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“…Experimental treatments against these impediments have resulted in first-in-man phase-I trials for human SCI including anti-Nogo-A antibody treatments [7], stem cell transplantation (HuCNS-SC: NCT01321333 identified in ClinicalTrials.gov) and drug administration (Riluzole: NCT00876889 identified in ClinicalTrials.gov; Minocycline: identified as NCT00559494 in ClinicalTrials.gov; for a review, see [8]). Although much has been learned from these trials, they suffer from a lack of adequate outcome assessments and sensitive biomarkers with the potential to stratify the highly diverse patients into homogenous cohorts and validate the efficacy of drugs [9,10]. To enable efficient translation, these interventions require biomarkers that can be used as surrogate makers of safety and efficacy of agents in a timely and economical manner [11].…”

Section: Introductionmentioning

confidence: 99%

Tracking trauma-induced structural and functional changes above the level of spinal cord injury

Huber

Curt

Freund

2015

Current Opinion in Neurology

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PURPOSE OF REVIEW: This review will highlight the latest findings from neuroimaging studies that track structural and functional changes within the central nervous system at both the brain and spinal cord levels following acute human spinal cord injury (SCI). The putative, underlying biological mechanisms of structural change (e.g. degradation of neural tissue) rostral to the lesion site will be discussed in relation to animal models of SCI and their potential value in clinical studies of human SCI. RECENT FINDINGS: Recent prospective studies in human acute SCI have begun to reveal the timecourse, spatial distribution and extent of structural changes following an acute SCI and their relation to functional outcome. Adaptive changes in sensory and motor pathways above the level of the lesion have prognostic value and complement clinical readouts. SUMMARY: The introduction of sensitive neuroimaging biomarkers will be an essential step forward in the implementation of interventional trials in which proof-of-concept is currently limited to clinical readouts, but more responsive measures are required to improve the sensitivity of clinical trials. Purpose of review This review will highlight the latest findings from neuroimaging studies that track structural and functional changes within the central nervous system at both the brain and spinal cord levels following acute human spinal cord injury (SCI). The putative, underlying biological mechanisms of structural change (e.g. degradation of neural tissue) rostral to the lesion site will be discussed in relation to animal models of SCI and their potential value in clinical studies of human SCI. Recent findingsRecent prospective studies in human acute SCI have begun to reveal the time-course, spatial distribution and extent of structural changes following an acute SCI and their relation to functional outcome. Adaptive changes in sensory and motor pathways above the level of the lesion have prognostic value and complement clinical readouts. SummaryThe introduction of sensitive neuroimaging biomarkers will be an essential step forward in the implementation of interventional trials in which proof-of-concept is currently limited to clinical readouts, but more responsive measures are required to improve the sensitivity of clinical trials.

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Section: Introductionmentioning

confidence: 99%

Tracking trauma-induced structural and functional changes above the level of spinal cord injury

Huber

Curt

Freund

2015

Current Opinion in Neurology

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“…Moreover, moderate neurologic improvements may get masked by spontaneous neurologic recovery early after injury, especially in patients with incomplete SCI. [2][3][4] Thus, larger sample sizes are required or potential study participants have to be excluded. Furthermore, primarily eligible patients have to be excluded as a result of severe concomitant injuries (for example, head trauma) or comorbidities, mental disorders, psychoactive substance abuse or communication barriers (for example, foreign languages), which preclude obtaining informed consent or represent confounding factors.…”

Section: Introductionmentioning

confidence: 99%

Study participation rate of patients with acute spinal cord injury early during rehabilitation

et al. 2015

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Study design: Retrospective observational study. Objectives: To investigate the study participation rate of patients with acute spinal cord injury (SCI) early during rehabilitation after conveying preliminary study information. Setting: Single SCI rehabilitation center in Switzerland. Methods: Newly admitted acute SCI patients receive a flyer to inform them concerning the purpose of clinical research, patient rights and active studies. Upon patient request, detailed study information is given. The rate of patients asking for detailed information (study interest) and the rate of study participation was evaluated from May 2013 to October 2014. Furthermore, the number of patients not withdrawing consent to the utilization of coded health-related data was determined. Results: The flyer was given to 144 of the 183 patients admitted during the observation period. A total of 96 patients (67%) were interested in receiving detailed information, and 71 patients (49%) finally participated in at least one study. The vast majority of patients (that is, 91%) did not withdraw consent for retrospective data analysis. An age over 60 years had a significantly (P ⩽ 0.023) negative effect on study interest and participation, and the consent rate to retrospective data analysis was significantly (Po0.04) lower in patients older than 75 years. Study interest and participation were reduced more than 5 and 14-fold, respectively, in patients older than 60 years. Conclusions: The relatively low (approximately 50%) study participation rates of acute SCI patients should be considered when planning clinical trials. The recruitment of patients older than 60 years may be reduced substantially.

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“…The prevalence of incomplete injuries is greater and the conversion rates from AIS A to B, C, or D are higher than previously reported. 7 The impact of motor recovery in SCI has been used to predict independence as it relates to scores on the Spinal Cord Independence Measure (SCIM); 8,9 however, the impact of early neurological recovery (0-3 months) and conversion as they relate to upper limb and hand function have yet to be explored. Some work has been done to explore the relationship between ISNCSCI upper extremity motor scores (UEMS) to the self-care subscale of the SCIM, which identifies clinically meaningful change.…”

Section: Introductionmentioning

confidence: 99%

Outcome of the upper limb in cervical spinal cord injury: Profiles of recovery and insights for clinical studies

Kalsi-Ryan¹,

Beaton²,

Curt³

et al. 2014

The Journal of Spinal Cord Medicine

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Background: Improved appreciation of recovery profiles of sensory and motor function as well as complex motor functions (prehension) after cervical spinal cord injury (SCI) will be essential to inform clinical studies to consider primary and secondary outcome measures for interventions and the optimization of dosing and timing of therapies in acute and chronic SCI. Objectives: (1) To define the sensory, motor, and prehension recovery profiles of the upper limb and hand in acute cervical SCI and (2) to confirm the impact of AIS severity and conversion on upper limb sensorimotor recovery. Methods: An observational longitudinal cohort study consisting of serial testing of 53 patients with acute cervical SCI was conducted. International Standards of Neurological Classification of Spinal Cord Injury, Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP), Capabilities of Upper Extremity (CUE-Q) Questionnaire, and Spinal Cord Independence Measure III (SCIM-III) were administered at 0-10 days, 1, 3, 6, and 12 months. Analysis: Change over time was plotted using mean and standard deviation of the total and subgroups of the sample. Results: Individuals with traumatic tetraplegia show distinct patterns of recovery. Factors that distinguish homogeneous subgroups of the sample are: severity of injury (level of injury, completeness) at baseline and conversion from a complete to an incomplete injury. Conclusions: In cervical SCI, clinical recovery can be assessed using standardized measures that distinguish levels of activity and impairment. Specific recovery profiles of the upper limb over the 1-year timecourse provide new insights and opportunity for combined analysis of recovery profiles for different clinical assessment tools of upper limb function which are meaningful to inform the design of study protocols.

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Prediction and Stratification of Upper Limb Function and Self-Care in Acute Cervical Spinal Cord Injury With the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP)

Cited by 41 publications

References 44 publications

Tracking trauma-induced structural and functional changes above the level of spinal cord injury

Tracking trauma-induced structural and functional changes above the level of spinal cord injury

Study participation rate of patients with acute spinal cord injury early during rehabilitation

Outcome of the upper limb in cervical spinal cord injury: Profiles of recovery and insights for clinical studies

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