Topics in Spinal Cord Injury Rehabilitation最新文献

{"title":"No Beneficial Effects of the Alfasigma VSL#3 Probiotic Treatment After Cervical Spinal Cord Injury in Rats.","authors":"Pamela J F Raposo, Antoinette T Nguyen, Emma K A Schmidt, Abel Torres Espin, Keith K Fenrich, David J Bennett, Karim Fouad","doi":"10.46292/sci24-00004","DOIUrl":"10.46292/sci24-00004","url":null,"abstract":"<p><strong>Background: </strong>The bidirectional communication between the gastrointestinal tract and the central nervous system appears to be linked to the intestinal microbiome. Research has shown that spinal cord injury (SCI) can disrupt the gut microbiome, leading to gut dysbiosis. These changes can have several negative impacts, such as exacerbated systemic inflammation and susceptibility to infection. Probiotics administered to mice with SCI have been shown to ameliorate gut dysbiosis, confer neuroprotection, and improve locomotor recovery. However, probiotics have also produced conflicting results, making potential claims regarding the application of probiotics as a therapeutic supplement ambiguous.</p><p><strong>Objectives: </strong>This study aimed to investigate the effects of a commercially available probiotic on recovery in a rat model of cervical SCI.</p><p><strong>Methods: </strong>Rats with cervical contusion SCI received probiotics over 7 days immediately after injury, and their recovery in motor, sensory, and cognitive tasks was compared to that of untreated animals.</p><p><strong>Results: </strong>Compared with a control group, the oral administration of probiotics influenced neither motor nor cognitive outcomes. We did observe a significantly different lesion size between the two groups, where the probiotic group had less spared tissue, despite a lack of differences in functional outcomes. In addition, probiotic treatment delayed gut microbiome composition recovery to baseline levels for up to 35 days postinjury (DPI). We found significantly higher proportions of <i>Lactobacillus</i> in the fecal matter of SCI-vehicle rats at 35 DPI, whereas <i>Streptococcus</i> was higher in SCI-probiotics fecal matter at 14 and 35 DPI, and <i>Bacillales</i> was higher in the latter group at 35 DPI.</p><p><strong>Conclusion: </strong>Taken together, our results do not support the application of the utilized probiotic cocktail as a dietary supplement for the treatment of cervical SCI-induced gut dysbiosis and secondary complications.</p>","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"31 1","pages":"1-16"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11848136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutritional Intakes of People With Spinal Cord Injury Who Have Pressure Injuries in Hospital: A Secondary Analysis of a Randomized Controlled Trial.","authors":"Amy N Nevin, Kathleen Dwyer, Sridhar S Atresh, Angela Vivanti, Ingrid J Hickman, Merrilyn Banks","doi":"10.46292/sci24-00003","DOIUrl":"10.46292/sci24-00003","url":null,"abstract":"<p><strong>Background: </strong>People living with spinal cord injury (SCI) have one of the highest rates of pressure injury prevalence globally, yet the nutrition-related characteristics of this group are inadequately described.</p><p><strong>Objectives: </strong>This secondary analysis aimed to explore the nutritional status, dietary intakes, and healing outcomes of people with SCI who have pressure injuries in hospital.</p><p><strong>Methods: </strong>Participant demographics, pressure injury-related information, anthropometry, nutritional status (subjective global assessment), and nutrition interventions were recorded. Assessments of energy and protein intake (24-hour dietary recalls), comparison with evidence-based guideline recommendations, and pressure injury healing (surface area measurements) were collected weekly until one of these occurred: complete healing, hospital discharge, surgical repair, or day 28. Factors associated with overall healing were explored using Mann-Whitney <i>U</i> tests.</p><p><strong>Results: </strong>Twenty-six people (mean age, 51 ± 14 years; 81% male) were included. Most were well nourished (77%), receiving dietetic input (85%), and on high-protein, high-energy diets (92%). Between 50% and 90% were exceeding energy and protein recommendations at all time points, and there was a weak negative correlation between energy intake and healing (<i>r</i> = -0.430, <i>P</i> = .036). Reduced healing was observed among participants with severe pressure injuries (stage 4 or unstageable, size >5 cm², >1 pressure injury present) and in those exceeding energy and protein recommendations (<i>P</i> < .05).</p><p><strong>Conclusion: </strong>People with SCI who have coexisting pressure injuries are at risk of excess intake that may be detrimental for pressure injury healing. Future studies examining the nutritional requirements of this population and the impact of both under- and overnutrition are critically needed to guide clinical care.</p>","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"31 1","pages":"17-29"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11848134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clarifications of the Motor Level Definition in the International Standards for Neurological Classification of Spinal Cord Injury in Not Clinically Testable Myotomes.","authors":"Christian Schuld, Steffen Franz, Laura Heutehaus, Kristen Walden, Gianna Rodriguez, James Guest, Fin Biering-Sørensen, Steven Kirshblum, Ruediger Rupp","doi":"10.46292/sci24-00094","DOIUrl":"https://doi.org/10.46292/sci24-00094","url":null,"abstract":"<p><strong>Background: </strong>In the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), two approaches for determining motor levels (MLs) in not clinically testable myotomes (C2-C4, T2-L1, S2-S5) are described: one where the motor level follows the sensory level (MFSL) and another deriving motor function from sensory function (MFSF). Their results differ when (1) all key muscles of an upper (or upper and lower) extremity are scored as intact, (2) sensation is not normal in key muscle segments, and (3) a contiguous region of normal sensation starts at T2 (or S2).</p><p><strong>Objectives: </strong>This work aims to characterize these cases and to discuss explanations.</p><p><strong>Methods: </strong>We analyzed 1330 early and late ISNCSCI assessments of 665 individuals from EMSCI.</p><p><strong>Results: </strong>Forty-nine (3.6% of all 2660 MLs) MFSL (63.3% T1, 36.7% S1) and MFSF MLs from 34 individuals differed without consequences on ASIA Impairment Scale (AIS) grades (4 AIS A, 1 AIS B, 29 AIS D). In 16 AIS D cases, all testable motor functions were intact, with a mean Spinal Cord Independence Measure (SCIM) total score of 95.67 ± 3.51 in 3 individuals with MFSL-ML T1 and 100 in 5 individuals with MFSL-ML S1. The MFSF-MLs are on average 9.63 ± 7.50 (T1: 12.16 ± 8.43; S1: 5.28 ± 1.36) segments caudal to the sensory level (SL).</p><p><strong>Conclusion: </strong>We identified and characterized rare cases with an unusual sensory impairment pattern, which could be explained by an isolated damage of afferent spinal tracts or the presence of non-SCI conditions. Further investigations of these case are necessary for a more conclusive ML definition.</p>","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"31 3","pages":"37-47"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12376153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"American Spinal Injury Association Impairment Scale Grade E Conversion After Spinal Cord Injury: Incidence, Conversion Characteristics, and Impact of Age on Functional Independence.","authors":"Gianmarco Brancato, Christian Schuld, Laura Heutehaus, Patrick Jersch, Doris Maier, Patrick Freund, Martin H Pouw, Giorgio Scivoletto, Norbert Weidner, Ruediger Rupp","doi":"10.46292/sci25-00009","DOIUrl":"10.46292/sci25-00009","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate incidence, conversion, neurological characteristics, and age-dependent functional independence of individuals with initial spinal cord injury (SCI) recovering to American Spinal Injury Association Impairment Scale (AIS) E, meaning normal sensory and motor functions according to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI).</p><p><strong>Methods: </strong>We analyzed 12,221 EMSCI (European Multicenter Study about Spinal Cord Injury) ISNCSCI datasets from 5 time points over the first year after SCI of 4286 individuals (age: 48.7 ± 19 years; 23% female; 92% traumatic, 8% ischemic).</p><p><strong>Results: </strong>Sixty-five of 82 individuals with at least one AIS E exam had an initial assessment within 6 weeks after injury with neurological level of injury peaking at C4 (16.9%) and L2 (15.4%), predominantly AIS grade D (89.2%), and mean total sensory/motor scores reaching 89.4% of their maximum. First AIS E conversion was detected at a median of 171 (interquartile range 274) days after injury. A change point analysis of Spinal Cord Independence Measure (SCIM) III assessments at the time of conversion of 75 AIS E individuals demonstrates a decline of full functional independence with age particularly over 70 years (<40, 76.9%; 40-70, 42.9%; >70, 14.3%).</p><p><strong>Conclusion: </strong>The current AIS E definition insufficiently reflects the reality experienced by older people without deficits in the ISNCSCI, as functional impairments remain predominantly in mobility-related activities. To detect whether these deficits are related to comorbidities attributable to aging rather than remnant deficits of SCI, functional assessments such as the SCIM should be performed in an age-matched non-SCI control group.</p>","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"31 3","pages":"48-60"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12376143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Grocery Shopping and Eating Behaviors Differ Between Persons With and Without a Spinal Cord Injury.","authors":"Zachary J Donato, Adam S Levy, Alicia Sneij, Sherri L LaVela, Arthur S Berg, Lauren T Shapiro, Gary J Farkas","doi":"10.46292/sci24-00028","DOIUrl":"10.46292/sci24-00028","url":null,"abstract":"<p><strong>Background: </strong>Spinal cord injury (SCI) heightens the susceptibility to neurogenic obesity, which is driven by alterations in energy metabolism and suboptimal dietary habits after injury. Those with SCI may adjust their grocery shopping and eating behaviors, notably influencing overall health outcomes.</p><p><strong>Objectives: </strong>To assess differences in grocery shopping and eating behaviors between persons with and without (controls) SCI.</p><p><strong>Methods: </strong>In an online, cross-sectional study, adults with (<i>n</i> = 207) and without (<i>n</i> = 52) SCI completed a one-time survey that assessed grocery shopping behavior (shopping frequency and who completed the shopping) and eating behaviors, including the frequency of consuming alcoholic beverages, fast food, and preferences for fried food. Regression analyses were employed for group comparisons, controlling for relevant measures.</p><p><strong>Results: </strong>Compared to the controls, a smaller proportion of persons with SCI grocery shopped independently in person (<i>P</i> = .002), and a greater proportion relied on others to fulfill grocery needs (<i>P</i> = .008). Individuals with SCI demonstrated a reduced monthly frequency of overall (<i>P</i> = .019) and independent in-person grocery shopping than controls (<i>P</i> = .014). In contrast, the monthly frequency of grocery shopping through delivery and from their caregivers was similar (<i>P</i> > .05). Fried food and fast-food intake were comparable (<i>P</i> > .05), whereas alcoholic beverage consumption was lower in individuals with SCI than controls (<i>P</i> = .006).</p><p><strong>Conclusion: </strong>People with SCI reported obtaining groceries less often than controls, and a greater proportion relied on others, rather than themselves, to fulfill grocery needs. These findings highlight the influence of SCI on biobehavioral activities affecting neurogenic obesity, suggesting potential targets for interventions to enhance health outcomes post-SCI.</p>","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"31 1","pages":"66-76"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11848133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Testing Battery for Preserved Autonomic Regulation Following Spinal Cord Injury and New Translationally Focused Data Representation.","authors":"Ryan Solinsky, Kathryn Burns, Jason W Hamner, Daniel D Veith, Wolfgang Singer, J Andrew Taylor","doi":"10.46292/sci24-00071","DOIUrl":"10.46292/sci24-00071","url":null,"abstract":"<p><strong>Background: </strong>Autonomic dysfunction is common after spinal cord injury (SCI). There are currently limited tools to comprehensively characterize its deficits. While individual established autonomic tests have a long history and sound scientific background, translating these autonomic testing results to inform clinical understanding is a major barrier.</p><p><strong>Objectives: </strong>To assess a strategic battery of autonomic tests to characterize and act as a biomarker of autonomic regulation for individuals with SCI and to develop a novel graphical representation of these data to facilitate understanding of autonomic dysfunction after SCI.</p><p><strong>Methods: </strong>We outline a battery of six laboratory autonomic tests that were curated to collectively describe the ability of individuals with SCI to inhibit and recruit sympathetic activity through the injured spinal cord. Heart rate/blood pressure variability, bolus phenylephrine, hand and foot cold pressor, Valsalva maneuver, and bladder pressor are herein described. Incorporating normative control data for 30 uninjured individuals completing this testing battery, we further demonstrate the utility of a composite biomarker, comparing these control results to 11 individuals with SCI.</p><p><strong>Results: </strong>Results demonstrate strong normality of data with testing psychometrics, suggesting stable reproducibility with repeat testing. Even in this preliminary sample of individuals with SCI, clear differences begin to emerge compared to uninjured norms. This illustrates the ability of this collective testing battery to characterize autonomic regulation after SCI. To aid in clinical translation, we further present a graphical representation, an <i>autonomic phenotype</i>, which serves as a snapshot of how normal or abnormal sympathetic inhibition and recruitment of activation may be after SCI.</p><p><strong>Conclusion: </strong>Utilizing these autonomic phenotypes, three example cases of individuals with SCI highlight evidence of varied degrees of autonomically complete SCI. Together, this represents a key advancement in our understanding of autonomic function after SCI.</p>","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"31 2","pages":"50-61"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12199568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Evaluation of International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) Performance Within the Canadian SCI Network.","authors":"Heather A Hong, Jessica Parsons, Jijie Xu, Kristen Walden, Nader Fallah, Christiana L Cheng, Najmedden Attabib, Sean D Christie, B Catharine Craven, Michael G Fehlings, Daryl R Fourney, Chester Ho, Lisa Julien, Brian K Kwon, Gary A Linassi, Adalberto Loyola-Sanchez, Saranjan Moganathas, Jerome Paquet, Vidya Sreenivasan, Jean-Marc Mac-Thiong, Andrea Townson, Eve C Tsai, Jennifer Urquhart, Alexander Whelan, Vanessa K Noonan","doi":"10.46292/sci25-00011","DOIUrl":"https://doi.org/10.46292/sci25-00011","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the performance of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) examination in individuals with traumatic spinal cord injury (TSCI) and nontraumatic spinal cord injury (NTSCI) across Canadian acute and rehabilitation facilities, evaluating timing, completeness, and classification accuracy.</p><p><strong>Methods: </strong>Using the Rick Hansen Spinal Cord Injury Registry (2015-2022), participants were analyzed across 6 cohorts: (A) TSCI-acute-admission (<i>n</i> = 4461), (B) TSCI-acute-discharge (<i>n</i> = 972), (C) TSCI-rehabilitation-admission (<i>n</i> = 2673), (D) TSCI-rehabilitation-discharge <i>(n</i> = 2316), (E) NTSCI-rehabilitation-admission (<i>n</i> = 728), and (F) NTSCI-rehabilitation-discharge <i>(n</i> = 619). ISNCSCI data included performed (yes/no), timing (≤72 hours, ≤7 days, and >7 days of admission/discharge), completeness, missing items, and worksheet used (yes/no). Classification accuracy between the clinician-determined and algorithm-generated ASIA Impairment Scale and neurological level of injury classification was evaluated. Descriptive and bivariate statistics were used to analyze cohorts.</p><p><strong>Results: </strong>Overall, 70% of participants had at least one examination performed, with 76% performed ≤72 hours, 91% ≤7 days, and 9% >7 days. However, 45% were partially complete, primarily missing sensory scores and rectal components ≤7 days. Comparison of TSCI and NTSCI during rehabilitation showed that NTSCI cohorts had significantly more exams at admission and fewer at discharge, with more complete exams. Moreover, age at injury, injury type, mechanism, severity, length of stay, and pain influenced examination performance.</p><p><strong>Conclusion: </strong>This study highlights the need for greater consistency in ISNCSCI examination performance and identifies patient-level barriers to completion. Determining the most effective standardized approach for ISNCSCI use across SCI care, addressing modifiable human/organizational factors, and ensuring comprehensive clinical training will improve the quality of this assessment.</p>","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"31 3","pages":"15-36"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12376162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age and Sex Affect the Chronic Trajectory of Plasma Neurofilament Light and Glial Fibrillary Acidic Protein Levels in a Murine Thoracic Contusion Spinal Cord Injury Model.","authors":"Bethany R Kondiles, Jianjia Fan, Wai Hang Cheng, Cheryl Wellington, Wolfram Tetzlaff","doi":"10.46292/sci24-00031","DOIUrl":"https://doi.org/10.46292/sci24-00031","url":null,"abstract":"<p><strong>Background: </strong>Mouse models of traumatic spinal cord injury (SCI) are used to understand pathophysiology and test potential interventions. Experimental injury parameters, deficits on functional tasks, and histology are used to assess severity and recovery. Blood biomarkers may be a promising additional metric to assess severity and detect efficacy of interventions, but they have not been examined previously in mouse spinal cord injury (SCI).</p><p><strong>Objectives: </strong>To examine blood biomarkers in mouse SCI.</p><p><strong>Methods: </strong>We measured plasma levels of neurofilament light (NfL) and glial fibrillary acidic protein (GFAP) longitudinally following a thoracic contusion SCI in adolescent (3 month old) and aged (18 month old) male and female C57Bl6/J mice. Biomarkers were also assessed in comparably aged uninjured animals.</p><p><strong>Results: </strong>Three-month-old animals exhibited elevated plasma NfL and GFAP 1 month after injury. NfL levels decreased from 1 to 2 months post injury but remained elevated from baseline, while GFAP levels remained high. Adolescent males exhibited higher NfL levels than females post injury. In aged animals, NfL was comparably elevated at 1 and 2 months post injury. In aged females, GFAP was elevated at 1 and 2 months after injury, while levels in males did not increase from baseline until 2 months after injury. Values from uninjured animals show plasma NfL and GFAP increase with age in absence of injury.</p><p><strong>Conclusion: </strong>In a mouse SCI model, plasma NfL and GFAP are elevated chronically after injury. Sex and age at injury may affect biomarker trajectories, which may indicate underlying pathology relevant to treatment and recovery. Establishing the trajectory of NfL and GFAP after experimental injury may help to standardize injury paradigms, assess recovery, and detect efficacy of interventions.</p>","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"31 2","pages":"125-134"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12464482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Model-Based Prediction of Motor Scores From Sensory Scores in the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI): Implications on Motor Levels in Segments Without Clinically Testable Key Muscles.","authors":"Christian Schuld, Viktoria Gavrilova, Laura Heutehaus, Doris Maier, Rainer Abel, Norbert Weidner, Ruediger Rupp, Steffen Franz","doi":"10.46292/sci25-00012","DOIUrl":"10.46292/sci25-00012","url":null,"abstract":"<p><strong>Background: </strong>In the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), motor levels are inferred from sensory levels for high cervical, thoracic, and low sacral injuries, as key muscles are only assessed in upper and lower extremities. This is known as the \"motor follows sensory level\" rule.</p><p><strong>Objectives: </strong>To develop regression models for estimating motor scores from sensory scores in segments without clinically testable key muscles and to validate the consensus-based \"motor follows sensory level\" approach.</p><p><strong>Methods: </strong>A total of 6940 ISNCSCI examinations from the European Multicenter Study about Spinal Cord Injury were reviewed. Multiple linear and random forest regression models were trained on scores in clinically testable segments to predict motor from sensory scores of the same spinal segment and side. Models based on ipsilateral light touch or pinprick scores alone, as well as all bilateral sensory scores, were also evaluated. Predicted motor scores were used to recalculate motor levels for the segments without clinically testable key muscles and compared to the true motor levels.</p><p><strong>Results: </strong>The ipsilateral regression models showed minimal differences (<i>R</i> ² 0.64-0.65; RMSE 1.34). Normal motor scores were predicted only for normal sensory function; in the linear model, this was captured by the equation: motor score = 0.18 + 1.22 * light touch score + 0.96 * pinprick score. Model-based motor levels were shifted caudally 0.18 segments (linear regression) and 0.32 segments (random forest regression).</p><p><strong>Conclusion: </strong>As models predict normal motor function only for normal sensory scores, predicted motor levels deviate only marginally, supporting the \"motor follows sensory level\" rule.</p>","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"31 3","pages":"129-139"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12376152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effects of Functional Electrical Stimulation Cycling on Muscle Spasticity in Individuals With Spinal Cord Injury: A Systematic Review.","authors":"Stephanie K Couper, Moira Smith","doi":"10.46292/sci23-00048","DOIUrl":"10.46292/sci23-00048","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the effects of functional electrical stimulation (FES) cycling on muscle spasticity in individuals with spinal cord injury (SCI) and provide recommendations for optimal FES cycling parameters to treat muscle spasticity.</p><p><strong>Method: </strong>In this systematic review, database searches of CINAHL, MEDLINE (Ovid), PEDro, PubMed, and Scopus were conducted to identify relevant studies published up to June 2023. Studies were screened for eligibility. Those that included an FES cycling intervention, an outcome measure of spasticity, and were available in full-text English were included. Two independent reviewers extracted the data and appraised the literature via the Crowe Critical Appraisal Tool (CCAT).</p><p><strong>Results: </strong>Of the 1782 studies identified, 16 satisfied the criteria for this review. Two-hundred and three participants were included, aged 7 to 80 years old. Ten studies identified a reduction in spasticity following FES cycling via objective or subjective outcome measures. Methodological quality was variable, with CCAT scores ranging from 19/40 (48%) to 35/40 (88%). National Health and Medical Research Council hierarchy levels ranged from II to IV.</p><p><strong>Conclusion: </strong>Evidence for the effectiveness of FES cycling to reduce muscle spasticity remains inconclusive. Long-term effects on spasticity were evident in moderate- to high-quality studies where FES cycling was conducted for 60 minutes, three times per week for 16 weeks. Additional research with larger sample sizes is warranted to confirm these findings. Further clarification of the optimal parameters of FES frequency, amplitude, and pulse width to reduce spasticity is required.</p>","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"31 1","pages":"77-99"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11848135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}