Journal of neurotrauma
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Journal of neurotrauma · Dec 2022
Enhanced network in corticospinal tracts after infused mesenchymal stem cells in spinal cord injury.
Although limited spontaneous recovery occurs after spinal cord injury (SCI), current knowledge reveals that multiple forms of axon growth in spared axons can lead to circuit reorganization and a detour or relay pathways. This hypothesis has been derived mainly from studies of the corticospinal tract (CST), which is the primary descending motor pathway in mammals. The major CST is the dorsal CST (dCST), being the major projection from cortex to spinal cord. ⋯ The AAV with advanced tissue clearing techniques were used to visualize the distribution pattern and high-resolution features of the individual axons coursing from above to below the lesion. The results demonstrated increased observable axonal connections between the dCST and axons in the lateral funiculus, both rostral and caudal to the lesion core, and an increase in observable axons in the dCST below the lesion. This increased axonal network could contribute to functional recovery by providing greater input to the spinal cord below the lesion.
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Journal of neurotrauma · Dec 2022
Minimal Clinically Important Difference of GRASSP Version 1 in Acute Cervical Traumatic Spinal Cord Injury.
The Graded Redefined Assessment of Strength, Sensibility, and Prehension Version 1 (GRASSP v1) is a validated measure of upper extremity impairment shown to be sensitive and responsive for traumatic cervical spinal cord injury (SCI) in both North American (NA) and European (EU) cohorts. The minimal clinically important difference (MCID) is the quantitative change in an assessment scale that patients perceive as being beneficial. Our aim was to establish the MCID of all subtests of the GRASSP v1 for cervical SCI. ⋯ Improvement in GRASSP v1 Strength and Prehension Performance scores of 12 and 6 are the MCID for the motor complete group, and 17 and 12 are the MCID for the motor incomplete group, respectively. The GRASSP v1 Strength subscore is the most sensitive for detecting meaningful clinical change in patients and is most closely related to measures of independence. Thus, use of GRASSP v1 Strength and Prehension Performance as measures of change is substantiated by this study.
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Journal of neurotrauma · Dec 2022
A Novel Method to Classify Cervical Incomplete Spinal Cord Injury based on Potential for Recovery: A Group-Based Trajectory Analysis.
The outcomes of cervical incomplete spinal cord injury (SCI) are heterogeneous. This study sought to dissociate subgroups of cervical incomplete SCI patients with distinct longitudinal temporal profiles of recovery in upper limb motor function. Patients with cervical incomplete SCI (American Spinal Injury Association Impairment Scale [AIS] B-D; C1-C8) were identified from four prospective, multi-center SCI datasets. ⋯ A classification model based on recursive partitioning could predict trajectory group using age, AIS grade, and neurological level with an area under the curve of 0.81. Patients with cervical incomplete SCI demonstrate distinct temporal profiles of recovery in upper limb motor function. The trajectory a patient is likely to follow may be predicted at baseline with fair accuracy.
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Journal of neurotrauma · Dec 2022
Incomplete Spinal Cord Syndromes: Current Incidence and Quantifiable Criteria for Classification.
The demographics of acute traumatic spinal cord injury (SCI) have changed over the last few decades, with a significant increase in age at the time of injury, a higher percentage of injuries caused by falls, and incomplete tetraplegia becoming the most common type of neurological impairment. Incomplete SCI syndromes, most specifically central cord syndrome (CCS), anterior cord syndrome (ACS) and Brown-Sequard syndrome (BSS), constitute a substantial proportion of incomplete tetraplegia and SCI overall. Nevertheless, the updated incidence of these syndromes is not well known, and their estimates vary considerably, largely because of methodological inconsistencies across previous studies. ⋯ Of the 1649 individuals with incomplete tetraplegia in our cohort, CCS was the most common syndrome (30%), followed by ACS (10%) and BSS (3%). Using quantifiable definitions, these three syndromes now account for ∼22% and ∼44% of cases of traumatic SCI and incomplete tetraplegia, respectively, with CCS having increased over the last decade. This updated information and proposed calculable criteria for these syndromes allow for a greater understanding of the incidence and characteristics of these syndromes and enable greater study in the future.
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Journal of neurotrauma · Dec 2022
Measuring hand use in the home after cervical spinal cord injury using egocentric video.
Egocentric video has recently emerged as a potential solution for monitoring hand function in individuals living with tetraplegia in the community, especially for its ability to detect functional use in the home environment. The aim of this study was to develop and validate a wearable vision-based system for measuring hand use in the home among individuals living with tetraplegia. Several deep learning algorithms for detecting functional hand-object interactions were developed and compared. ⋯ Our results demonstrated that higher UEMS and better prehension were related to greater time spent interacting, whereas higher SCIM and better hand sensation resulted in a higher number of interactions performed during the egocentric video recordings. For the first time, measures of hand function automatically estimated in an unconstrained environment in individuals with tetraplegia have been validated against internationally accepted measures of hand function. Future work will necessitate a formal evaluation of the reliability and responsiveness of the egocentric-based performance measures for hand use.