Recovery from a Spinal Cord Injury: Significance of Compensation, Neural Plasticity, and Repair

Curt, Armin; Hedel, Hubertus J. A. van; Klaus, Daniel A.; Dietz, Volker

doi:10.1089/neu.2007.0468

Cited by 271 publications

(231 citation statements)

References 39 publications

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“…84 In a longitudinal study, persons with motorincomplete SCI demonstrated increased amplitude of motor evoked potentials over the course of the first post-injury year (with no associated change in latency). 85 While the sample sizes in some subgroups were too small to reach statistical significance, the mean change in motor evoked potentials suggests a parallel between cortical connectivity and motor scores.…”

Section: Training-related Modulation Of Supraspinal Circuitsmentioning

confidence: 97%

Supraspinal Control Predicts Locomotor Function and Forecasts Responsiveness to Training after Spinal Cord Injury

Field-Fote

Yang

Basso

et al. 2017

Journal of Neurotrauma

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Restoration of walking ability is an area of great interest in the rehabilitation of persons with spinal cord injury. Because many cortical, subcortical, and spinal neural centers contribute to locomotor function, it is important that intervention strategies be designed to target neural elements at all levels of the neuraxis that are important for walking ability. While to date most strategies have focused on activation of spinal circuits, more recent studies are investigating the value of engaging supraspinal circuits. Despite the apparent potential of pharmacological, biological, and genetic approaches, as yet none has proved more effective than physical therapeutic rehabilitation strategies. By making optimal use of the potential of the nervous system to respond to training, strategies can be developed that meet the unique needs of each person. To complement the development of optimal training interventions, it is valuable to have the ability to predict future walking function based on early clinical presentation, and to forecast responsiveness to training. A number of clinical prediction rules and association models based on common clinical measures have been developed with the intent, respectively, to predict future walking function based on early clinical presentation, and to delineate characteristics associated with responsiveness to training. Further, a number of variables that are correlated with walking function have been identified. Not surprisingly, most of these prediction rules, association models, and correlated variables incorporate measures of volitional lower extremity strength, illustrating the important influence of supraspinal centers in the production of walking behavior in humans.

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Section: Training-related Modulation Of Supraspinal Circuitsmentioning

confidence: 97%

Supraspinal Control Predicts Locomotor Function and Forecasts Responsiveness to Training after Spinal Cord Injury

Field-Fote

Yang

Basso

et al. 2017

Journal of Neurotrauma

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“…Information collected from international SCI registries, such as the European Multi-center Study about Spinal Cord Injury, has already contributed to large-scale observational studies on topics such as American Spinal Injury Association (ASIA) Impairment Scale (AIS) validation 3 and spontaneous recovery patterns. 4 Other SCI registries such as the US Model SCI Database have contributed greatly to our understanding of the epidemiology of traumatic SCI 5 and predictors of participation and quality of life following injury. 6 In Canada, the first SCI patient registry known as the Rick Hansen Spinal Cord Injury Registry (RHSCIR) was launched in 2004.…”

Section: Introductionmentioning

confidence: 99%

The Rick Hansen Spinal Cord Injury Registry (RHSCIR): a national patient-registry

et al. 2011

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Study design: Development of a prospective patient registry. Objective: To develop a patient registry for persons with traumatic spinal cord injuries (SCI), which can be used to answer research questions and improve patient outcomes. Setting: Nine provinces in Canada. Methods: The Rick Hansen Spinal Cord Injury Registry (RHSCIR) is part of the Translational Research Program of the Rick Hansen Institute. The launch of RHSCIR in 2004 heralded the initiation of the first nation-wide SCI patient registry within Canada. Currently, RHSCIR is being implemented in 14 cities located in 9 provinces, and there are over 1500 individuals who have sustained an acute traumatic SCI registered to date. Data are captured from the pre-hospital, acute and rehabilitation phases of care, and participants are followed in the community at 1, 2, 5 and then every 5 years post-injury. Results: During the development of RHSCIR, there were many challenges that were overcome in selecting data elements, establishing the governance structure, and creating a patient privacy and confidentiality framework across multiple provincial jurisdictions. The benefits of implementing a national registry are now being realized. The collection of an internationally standardized set of clinical information is helping inform clinicians of beneficial interventions and encouraging a shift towards evidence-based practices. Furthermore, through RHSCIR, a network is forming amongst SCI clinicians and researchers, which is fostering new collaborations and the launch of multi-center clinical trials. Conclusions: For networks that are establishing SCI registries, the experiences and lessons learned in the development of RHSCIR may provide useful insights and guidance.

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“…However, Burns et al 9 reported that in chronic subjects, the assessment of maximum WISCI II level by the two examiners differed in two of 63 (3%) cases, with higher reliability coefficients than those reported in our study. Therefore, according to previous studies 18,19 that state that measurement errors, and thus the reliability of a measure, are not a fixed property but are dependent on the studied population, in the effort of improving the generalizability of the WISCI II, we decided to enlarge our pilot study on acute SCI patients.The rationale for examining the highest WISCI II level has been presented by several studies of chronic patients. 8,9,20 Reliability and responsiveness The reliability of the WISCI was established in its development when a videotape of patients who were walking at each level (40 randomized clips) was circulated to SCI experts.…”

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confidence: 99%

Walking Index for Spinal Cord Injury version II in acute spinal cord injury: reliability and reproducibility

et al. 2013

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Study design: Administration of the walking index for SCI (WISCI) II is recommended to assess walking in spinal cord injury (SCI) patients. Determining the reliability and reproducibility of the WISCI II in acute SCI would be invaluable. Objectives: The objective of this study is to assess the reliability and reproducibility of the WISCI II in patients with traumatic, acute SCI. Design: Test-retest analysis and calculation of reliability and smallest real difference (SRD). Setting: SCI unit of a rehabilitation hospital. Methods: Thirty-three patients, median age 44 years, median time since onset of SCI 40 days. Level: 20 cervical, 8 thoracic, 5 lumbar; ASIA (American Spinal Injury Association) impairment scale (AIS) grade: 32 D/1 C. Assessment of maximum WISCI II levels by two trained, blinded raters to evaluate interrater (IRR) and intrarater reliability. Results: The intrarater reliability was 0.999 for therapists A and 0.979 for therapists B, for the maximum WISCI II level. The IRR for the maximum WISCI II score was 0.996 on day 1 and 0.975 on day 2. The SRD for the maximum WISCI II score was 1.147 for tetraplegics and 1.682 for paraplegics. These results suggest that a change of two WISCI II levels could be considered real. Conclusions:The WISCI II has high IRR and intrarater reliability and good reproducibility in the acute and subacute phase when administered by trained raters. Spinal Cord (2014) 52, 65-69; doi:10.1038/sc.2013.127; published online 22 October 2013Keywords: spinal cord injury; walking; WISCI II; reliability; reproducibility INTRODUCTIONValid and reliable outcome measures in clinical trials on spinal cord injuries (SCIs) must be generated to develop effective treatment interventions-a necessity that is particularly true for walking function, which is a principal goal for subjects with SCIs. 1 Thus, it is conceivable that many clinical trials will be geared toward walking recovery and require valid outcome measures. Outcome measures that are related to walking function include measures of walking capacity, such as short-distance timed walk, long distance (6-min walk) and the walking index for SCI (WISCI II).The WISCI was introduced in 2000 2 and modified in 2001 (WISCI II) 3 as a measure of the capacity to walk for use in clinical trials, incorporating the use of walking aids, braces and physical assistance on a 21-point scale. The WISCI was ranked by an international group of SCI clinicians and investigators from most impaired to least impaired, and has demonstrated theoretical construct and face validity. It was subsequently compared with four scales in a clinical population of mixed SCI and spinal cord lesions to validate its retrospective criteria (versus other scales). 4 In 2006, the WISCI was used in a multicenter, randomized clinical trial, as assessed by blinded observers, and correlated well with lower extremity motor score, balance, walking speed, 6-min walking distance and locomotor functional independence measure score, validating its prospective criteria. 5 Since then, the WISCI ...

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Recovery from a Spinal Cord Injury: Significance of Compensation, Neural Plasticity, and Repair

Cited by 271 publications

References 39 publications

Supraspinal Control Predicts Locomotor Function and Forecasts Responsiveness to Training after Spinal Cord Injury

Supraspinal Control Predicts Locomotor Function and Forecasts Responsiveness to Training after Spinal Cord Injury

The Rick Hansen Spinal Cord Injury Registry (RHSCIR): a national patient-registry

Walking Index for Spinal Cord Injury version II in acute spinal cord injury: reliability and reproducibility

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