Providing the clinical basis for new interventional therapies: refined diagnosis and assessment of recovery after spinal cord injury

Curt, Armin; Schwab, Martin E.; Dietz, Volker

doi:10.1038/sj.sc.3101558

Cited by 164 publications

(118 citation statements)

References 49 publications

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“…training effects in preserved physical resources [1][2][3] . In CNS lesions, movement performance is limited by muscle weakness (paresis) as well as by deficits in movement dexterity that are not attributable to motor weakness 4,5 .…”

Section: Introductionmentioning

confidence: 99%

“…However, the clinical scoring of strength, such as proposed by the American Spinal Injury Association (ASIA), primarily addresses force generation, which is only one of the components involved in the recovery of motor function after spinal cord injury (SCI) 1,2,[6][7][8] . Assessing the recovery of walking function (timed and qualitative walking tests) in patients with incomplete spinal cord injury (iSCI) 9,10 indicates a complex outcome measure, which does not allow for a conclusion to be made regarding specific changes within the nervous system [11][12][13] .…”

Section: Introductionmentioning

confidence: 99%

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Foot control in incomplete SCI: distinction between paresis and dexterity

Wirth

Hedel

Curt

2008

Neurological Research

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Objective: To complement the clinical assessment of motor impairment after incomplete spinal cord injury (iSCI) by introducing a test that reliably distinguishes between muscle weakness (paresis) and impairment of dexterity in a simple foot motor task. Methods: Auditory-paced ankle dorsi-and plantarflexion, in a supine position, was studied in 30 controls (to establish control values and to test reliability) and in 16 iSCI patients (test validation). The subjects were instructed to initiate dorsi-and plantarflexion as accurately in timing and with the largest range of motion (ROM) possible. For each frequency, accuracy of timing, ROM, peak velocity of dorsi-and plantarflexion and a time quotient for changing from dorsi-to plantarflexion and vice versa were determined. In iSCI subjects, these parameters were related to clinical measures of paresis, spasticity and proprioception. Results: The test parameters showed good to very good reliability. The iSCI subjects were able to follow the target frequency with high accuracy, while ROM and peak velocity for dorsi-and plantarflexion were significantly reduced. Furthermore, there was a strong correlation between ROM/peak velocities and motor scores within the iSCI patients. Discussion: Repetitive foot dorsi-and plantarflexion enables a distinction to be made between muscle weakness and reduced dexterity as the underlying cause of affected foot control. This distinction between and quantification of these two movement components complements the existing clinical examination, and in follow-up works, the recovery of these components may provide further insight into the mechanisms underlying motor function improvement after iSCI. [Neurol Res 2008; 30: 52-60]

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Foot control in incomplete SCI: distinction between paresis and dexterity

Wirth

Hedel

Curt

2008

Neurological Research

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“…Several longitudinal cohort projects collecting data on SCI have been conducted since the 1970s. Large studies such as Spinal Cord Injury Model System, 41 European Multicenter Study About Spinal Cord Injury, 42 Restoration of Mobility in SCI Rehabilitation: the Umbrella Project from Netherlands 43 and Australian Spinal Cord Injury Register 44 failed to comprehensively cover functional aspects determined in the Brief ICF Core Set for SCI. 45 One large epidemiologic study that looks at SCI from a comprehensive perspective is the Swiss Spinal Cord Injury Study (SwiSCI).…”

Section: Discussionmentioning

confidence: 99%

Need for a comprehensive epidemiologic study of spinal cord injury in Poland: findings from a systematic review

et al. 2013

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Objective: To review and assess the quality of available epidemiologic data of spinal cord injury (SCI) in Poland in the context of general International Classification of Functioning (ICF) domains and to answer the question whether there is a need for a comprehensive epidemiologic study of SCI in Poland. Methods: Databases Medline, Embase and Polish Medical Bibliography were searched using keywords 'spinal cord injury', 'paraplegia', 'tetraplegia' and 'Poland'. Inclusion criteria: studies on humans, original papers, publication in 1979 or later. Case reports and studies with unclear inclusion criteria or performed on a population other than Polish were excluded. Full texts were reviewed for data on incidence, prevalence, etiology, mortality, natural history and outcome of comprehensive treatment. Quality of studies was assessed according to the modified Downs and Black criteria. The ICF model was applied to group the studies according to the ICF components. Results: Out of 536 identified papers, 224 articles were extracted and reviewed. Mean quality score was 11.04 points based on a 28-grade scale. Body functions and structures were assessed in 81.6%, activities in 22.4%, participation in 14.8%, environmental factors in 15.2% and personal factors in 47% of the studies reviewed. Conclusion: Current epidemiologic data on SCI in Poland are insufficient and biased toward biomedical aspects. There is a need to develop a long-term research strategy for SCI in Poland in the form of a comprehensive cohort study. Spinal Cord (2013) 51, 802-808; doi:10.1038/sc.2013.105; published online 17 September 2013Keywords: spinal cord injury; Poland; paraplegia; tetraplegia INTRODUCTIONMany people with disabilities worldwide, including those in Poland, do not have equal access to health care, education, employment and experience exclusion from activities of everyday life. 1 On 6 September 2012, Poland ratified the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), which aims to ensure the equality of rights and opportunities for persons with disabilities. 2 Disability associated with spinal cord injury (SCI) is serious and can last a lifetime. All organs and systems below the level of lesion can be affected. In addition to the loss of sensory and somatic functions, a wide range of other functional and structural problems is observed in individuals with SCI. These may include cardiovascular and respiratory problems, spasticity, neurogenic bladder and bowel, sexual dysfunction and neurogenic pain. SCI also increases the risk of respiratory and urinary complications, pressure sores, gastrointestinal bleeding, osteoporosis, male infertility, diabetes mellitus, ischemic heart disease, depression and suicide. SCI affects health-related quality of life and is associated with increased preterm mortality. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Health and social care expenditure related to SCI varies according to severity of injury, but is generally high. Inpatient rehabilitation appears to be ...

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“…[1][2][3][4][5] These interventions can be subdivided into those that exert effects through putative neuroprotective, 6 regenerative 7-9 or plasticity-inducing 10,11 mechanisms, many of which have been substantiated through further in vivo, or in vitro, experiments. However, although an intervention might show great promise by alleviating the effects of SCI in an experimental animal model, there are many differences between experimental SCI in rodent models and the clinical injuries that occur in human patients.…”

Section: Introductionmentioning

confidence: 99%

Clinical canine spinal cord injury provides an opportunity to examine the issues in translating laboratory techniques into practical therapy

et al. 2006

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Study design: Review. Objectives: To highlight the value of investigating the effects of putative therapeutic interventions in clinical spinal cord injury (SCI) in domestic dogs. Setting: England, UK. Methods: Many experimental interventions in laboratory rodents have been shown to ameliorate the functional deficits caused by SCI; the challenge now is to determine whether they can be translated into useful clinical techniques. Important differences between clinical SCI in human patients and that in laboratory rodents are in the size of the spinal cord and heterogeneity of injury severity. A further key issue is whether the statistical difference in outcome in the laboratory will translate into a useful difference in clinical outcome. Here, we stress the value of investigating the effects of putative therapies in clinical SCI in domestic dogs. The causes of injury, ability to categorise the severity and methods available to measure outcome are very similar between canine and human patients. Furthermore, postmortem tissue more rapidly becomes available from dogs because of their short lifespan than from human patients. Results: The role that investigation of canine SCI might play is illustrated by our preliminary trials on intraspinal transplantation of olfactory glial cells for severe SCI. Conclusions: This canine translational model provides a means of 'filtering' putative treatments before human application.

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Providing the clinical basis for new interventional therapies: refined diagnosis and assessment of recovery after spinal cord injury

Cited by 164 publications

References 49 publications

Foot control in incomplete SCI: distinction between paresis and dexterity

Foot control in incomplete SCI: distinction between paresis and dexterity

Need for a comprehensive epidemiologic study of spinal cord injury in Poland: findings from a systematic review

Clinical canine spinal cord injury provides an opportunity to examine the issues in translating laboratory techniques into practical therapy

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