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Study design:Literature review.Objectives:To review the main published current neuroprotection research trends and results in spinal cord injury (SCI).Setting:This paper is the result of a collaboration between a group of European scientists.Methods:Recent studies, especially in genetic, immune, histochemical and bio (nano)-technological fields, have provided new insight into the cellular and molecular mechanisms occurring within the central nervous system (NS), including SCIs. As a consequence, a new spectrum of therapies aiming to antagonize the ‘secondary injury’ pathways (that is, to provide neuroprotection) and also to repair such classically irreparable structures is emerging. We reviewed the most significant published works related to such novel, but not yet entirely validated, clinical practice therapies.Results:There have been identified many molecules, primarily expressed by heterogenous glial and neural subpopulations of cells, which are directly or indirectly critical for tissue damaging/sparing/re-growth inhibiting, angiogenesis and neural plasticity, and also various substances/energy vectors with regenerative properties, such as MAG (myelin-associated glycoprotein), Omgp (oligodendrocyte myelin glycoprotein), KDI (synthetic: Lysine–Asparagine–Isoleucine ‘γ-1 of Laminin Kainat Domain’), Nogo (Neurite outgrowth inhibitor), NgR (Nogo protein Receptor), the Rho signaling pathway (superfamily of 'Rho-dopsin gene—including neurotransmitter—receptors'), EphA4 (Ephrine), GFAP (Glial Fibrillary Acidic Protein), different subtypes of serotonergic and glutamatergic receptors, antigens, antibodies, immune modulators, adhesion molecules, scavengers, neurotrophic factors, enzymes, hormones, collagen scar inhibitors, remyelinating agents and neurogenetic/plasticity inducers, all aiming to preserve/re-establish the morphology and functional connections across the lesion site. Accordingly, modern research and experimental SCI therapies focus on several intricate, rather overlapping, therapeutic objectives and means, such as neuroprotective, neurotrophic, neurorestorative, neuroreparative, neuroregenerative, neuro(re)constructive and neurogenetic interventions.Conclusion:The first three of these therapeutical directions are generically assimilated as neuroprotective, and are synthetically presented and commented in this paper in an attempt to conceptually systematize them; thus, the aim of this article is, by emphasizing the state-of-the art in the domain, to optimize theoretical support in selecting the most effective pharmacological and physical interventions for preventing, as much as possible, paralysis, and for maximizing recovery chances after SCI. [ABSTRACT FROM AUTHOR]

STUDY DESIGN::Review. OBJECTIVES::To explore the concept of quality of life (QOL), critique the practice and problems of assessing QOL following spinal cord injury (SCI) and to review the findings of studies into QOL for people with SCI both below and above the level of C4. METHODS::Relevant articles were identified from the Medline and CINAHL databases for approximately the period 1990-2003, cross-indexing‘spinal cord injury’or‘quadriplegia/tetraplegia’with‘quality of life’,‘life satisfaction’,‘social adjustment’or‘psychological adaptation’. This search was augmented through papers identified in reference lists. Articles were excluded if they were designed solely to examine the impact of a specific intervention upon QOL; or if they examined satisfaction with various life domains without explicitly linking these to perceptions of QOL. Papers were also accessed that addressed the philosophical and epistemological issues involved in QOL conceptions and assessment. RESULTS::Review of the literature highlights the philosophical and methodological difficulties associated with the quantitative measurement of a qualitative experience; and with the assessment of life domains chosen by researchers. Analysis of QOL research undertaken among people with all levels of SCI demonstrates that dissatisfaction with life following injury arises primarily from social disadvantage. However, little research has been conducted specifically to ascertain perceptions of QOL among people with high SCI. CONCLUSIONS::Ensuring the relevance of future research into QOL following high SCI requires qualitative methodology and mixed methods. Further research is needed to determine how rehabilitation professionals can act on the findings of their QOL assessments and enhance the QOL experienced by people with spinal cord injury in the context of their environments. SPONSORSHIP::The early phase of this study was supported by: University of British Columbia Graduate Fellowship; Rick Hansen Man in Motion Foundation (studentship); Social Sciences and Humanities Research Council of Canada: doctoral fellowship.Spinal Cord (2004) 42, 491-502. doi:10.1038/sj.sc.3101636 Published online 20 July 2004 [ABSTRACT FROM AUTHOR]

Study design:Experts opinions consensus.Objective:To develop a common strategy to document remaining autonomic neurologic function following spinal cord injury (SCI).Background and Rationale:The impact of a specific SCI on a person's neurologic function is generally described through use of the International Standards for the Neurological Classification of SCI. These standards document the remaining motor and sensory function that a person may have; however, they do not provide information about the status of a person's autonomic function.Methods:Based on this deficiency, the American Spinal Injury Association (ASIA) and the International Spinal Cord Society (ISCoS) commissioned a group of international experts to develop a common strategy to document the remaining autonomic neurologic function.Results:Four subgroups were commissioned: bladder, bowel, sexual function and general autonomic function. On-line communication was followed by numerous face to face meetings. The information was then presented in a summary format at a course on Measurement in Spinal Cord Injury, held on June 24, 2006. Subsequent to this it was revised online by the committee members, posted on the websites of both ASIA and ISCoS for comment and re-revised through webcasts. Topics include an overview of autonomic anatomy, classification of cardiovascular, respiratory, sudomotor and thermoregulatory function, bladder, bowel and sexual function.Conclusion:This document describes a new system to document the impact of SCI on autonomic function. Based upon current knowledge of the neuroanatomy of autonomic function this paper provides a framework with which to communicate the effects of specific spinal cord injuries on cardiovascular, broncho-pulmonary, sudomotor, bladder, bowel and sexual function.Spinal Cord (2009) 47, 36–43; doi:10.1038/sc.2008.121; published online 28 October 2008 [ABSTRACT FROM AUTHOR]

The International Campaign for Cures of Spinal Cord Injury Paralysis established a panel tasked with reviewing the methodology for clinical trials for spinal cord injury (SCI), and making recommendations on the conduct of future trials. This is the third of four papers. It examines inclusion and exclusion criteria that can influence the design and analysis of clinical trials in SCI, together with confounding variables and ethical considerations. Inclusion and exclusion criteria for clinical trials should consider several factors. Among these are (1) the enrollment of subjects at appropriate stages after SCI, where there is supporting data from animal models or previous human studies; (2) the severity, level, type, or size of the cord injury, which can influence spontaneous recovery rate and likelihood that an experimental treatment will clinically benefit the subject; and (3) the confounding effects of various independent variables such as pre-existing or concomitant medical conditions, other medications, surgical interventions, and rehabilitation regimens. An issue of substantial importance in the design of clinical trials for SCI is the inclusion of blinded assessments and sham surgery controls: every effort should be made to address these major issues prospectively and carefully, if clear and objective information is to be gained from a clinical trial. The highest ethical standards must be respected in the performance of clinical trials, including the adequacy and clarity of informed consent.Spinal Cord (2007) 45, 222–231. doi:10.1038/sj.sc.3102009; published online 19 December 2006 [ABSTRACT FROM AUTHOR]

The International Campaign for Cures of Spinal Cord Injury Paralysis (ICCP) supported an international panel tasked with reviewing the methodology for clinical trials in spinal cord injury (SCI), and making recommendations on the conduct of future trials. This is the first of four papers. Here, we examine the spontaneous rate of recovery after SCI and resulting consequences for achieving statistically significant results in clinical trials. We have reanalysed data from the Sygen trial to provide some of this information. Almost all people living with SCI show some recovery of motor function below the initial spinal injury level. While the spontaneous recovery of motor function in patients with motor-complete SCI is fairly limited and predictable, recovery in incomplete SCI patients (American spinal injury Association impairment scale (AIS) C and AIS D) is both more substantial and highly variable. With motor complete lesions (AIS A/AIS B) the majority of functional return is within the zone of partial preservation, and may be sufficient to reclassify the injury level to a lower spinal level. The vast majority of recovery occurs in the first 3 months, but a small amount can persist for up to18 months or longer. Some sensory recovery occurs after SCI, on roughly the same time course as motor recovery. Based on previous data of the magnitude of spontaneous recovery after SCI, as measured by changes in ASIA motor scores, power calculations suggest that the number of subjects required to achieve a significant result from a trial declines considerably as the start of the study is delayed after SCI. Trials of treatments that are most efficacious when given soon after injury will therefore, require larger patient numbers than trials of treatments that are effective at later time points. As AIS B patients show greater spontaneous recovery than AIS A patients, the number of AIS A patients requiring to be enrolled into a trial is lower. This factor will have to be balanced against the possibility that some treatments will be more effective in incomplete patients. Trials involving motor incomplete SCI patients, or trials where an accurate assessment of AIS grade cannot be made before the start of the trial, will require large subject numbers and/or better objective assessment methods.Spinal Cord (2007) 45, 190–205. doi:10.1038/sj.sc.3102007; published online 19 December 2006 [ABSTRACT FROM AUTHOR]

An international panel reviewed the methodology for clinical trials of spinal cord injury (SCI), and provided recommendations for the valid conduct of future trials. This is the second of four papers. It examines clinical trial end points that have been used previously, reviews alternative outcome tools and identifies unmet needs for demonstrating the efficacy of an experimental intervention after SCI. The panel focused on outcome measures that are relevant to clinical trials of experimental cell-based and pharmaceutical drug treatments. Outcome measures are of three main classes: (1) those that provide an anatomical or neurological assessment for the connectivity of the spinal cord, (2) those that categorize a subject's functional ability to engage in activities of daily living, and (3) those that measure an individual's quality of life (QoL). The American Spinal Injury Association impairment scale forms the standard basis for measuring neurologic outcomes. Various electrophysiological measures and imaging tools are in development, which may provide more precise information on functional changes following treatment and/or the therapeutic action of experimental agents. When compared to appropriate controls, an improved functional outcome, in response to an experimental treatment, is the necessary goal of a clinical trial program. Several new functional outcome tools are being developed for measuring an individual's ability to engage in activities of daily living. Such clinical end points will need to be incorporated into Phase 2 and Phase 3 trials. QoL measures often do not correlate tightly with the above outcome tools, but may need to form part of Phase 3 trial measures.Spinal Cord (2007) 45, 206–221. doi:10.1038/sj.sc.3102008; published online 19 December 2006 [ABSTRACT FROM AUTHOR]

The International Campaign for Cures of Spinal Cord Injury Paralysis established a panel tasked with reviewing the methodology for clinical trials for spinal cord injury (SCI), and making recommendations on the conduct of future trials. This is the fourth of four papers. Here, we examine the phases of a clinical trial program, the elements, types, and protocols for valid clinical trial design. The most rigorous and valid SCI clinical trial would be a prospective double-blind randomized control trial utilizing appropriate placebo control subjects. However, in specific situations, it is recognized that other trial procedures may have to be considered. We review the strengths and limitations of the various types of clinical trials with specific reference to SCI. It is imperative that the design and conduct of SCI clinical trials should meet appropriate standards of scientific inquiry to insure that meaningful conclusions about efficacy and safety can be achieved and that the interests of trial subjects are protected. We propose these clinical trials guidelines for use by the SCI clinical research community.Spinal Cord (2007) 45, 232–242. doi:10.1038/sj.sc.3102010; published online 19 December 2006 [ABSTRACT FROM AUTHOR]

This paper seeks to consider the validity and utility of two related terms in spinal and other injuries: complex regional pain syndrome (CRPS) and chronic pain syndrome (CPS). It is argued that the words chronic regional pain syndrome convey neither understanding of the condition nor of its mechanism. They simply redefine the clinical problem, but fail to establish specific diagnostic features or consistent primary pathogenesis. CRPS is best construed as a reaction to injury, or to excessive, often iatrogenic, immobilization after injury; but it is not an independent disease. The diagnosis of CPS groups together ill-defined symptoms under a convenient, but medically untestable and therefore inept label. Patients, lawyers, and support groups commonly deny psychogenesis, with the sadly mistaken notion that this implies a bogus or spurious cause.Spinal Cord (2005) 43, 263-268. doi:10.1038/sj.sc.3101709 Published online 4 January 2005 [ABSTRACT FROM AUTHOR]

Study design:This manuscript summarizes recommendations from the State of the Science Conference in Spinal Cord Injury Rehabilitation 2011.Objectives:To develop an agenda for spinal cord injury (SCI) rehabilitation research in the next decade.Setting:Participants scheduled planning meetings and then gathered at the 2011 joint meeting of the American Spinal Injury Association and International Spinal Cord Society in Washington DC.Methods:Recommendations were made by an international, multidisciplinary team that met in large plenary sessions and breakout groups during the meeting.Results:Recommendations are organized by conference track, including neurological and functional recovery; technology issues; aging with spinal cord injury; and employment, psychosocial and quality of life issues.Conclusion:A number of themes emerged across the conference tracks, including the need for improved measures of process and outcome constructs, application of qualitative and quantitative research designs, and use of contemporary statistical analytic approaches. Participants emphasized the value of collaborative research that uses the latest methods, techniques and information. [ABSTRACT FROM AUTHOR]

The article discusses various reports published within the issue including one autonomic assessment of animals with spinal cord injury and one other on the international standards to document the remaining autonomic function after spinal cord injury provides a direct clinical link.

Study design:A systematic search of the literature.Objectives:To critically review instruments that assess participation in persons with spinal cord injury (SCI).Setting:Vancouver, British Columbia.Methods:Four electronic databases (MEDLINE/PubMed, CINAHL, EMBASE and PsychInfo) were searched for studies published between 1980 and March 2008. Instruments were included if information was published in English in at least one peer-reviewed journal on its measurement properties (reliability, validity and responsiveness) in a sample that included adults with SCI. Instruments were evaluated using criteria proposed for disability outcome measures.Results:Six instruments were included: Craig Handicap Assessment and Reporting Technique (CHART); Impact on Participation and Autonomy Questionnaire (IPA); Assessment of Life Habits Scale (Life-H); Occupational Performance History Interview; Physical Activity Recall Assessment for People with Spinal Cord Injury; and Reintegration to Normal Living Index. Evidence supporting the reliability of the instruments was reported for four of the six instruments and was adequate. Validity was assessed in all the instruments. Only the Life-H and CHART have been compared with each other. No evidence on responsiveness was available.Conclusion:The instruments differ in how participation is operationalized. Currently, the CHART that measures objective aspects of participation has the most evidence supporting its measurement properties. More evidence is becoming available for instruments such as the IPA, which consider the person's perspective. It is important to determine what information about participation is required before selecting an instrument.Sponsorship:Rick Hansen Foundation, Ontario Neurotrauma Fund.Spinal Cord (2009) 47, 435–446; doi:10.1038/sc.2008.171; published online 24 February 2009 [ABSTRACT FROM AUTHOR]

Study design:Compact literature review to provide basic knowledge of the reticular formation (RF) for clinicians.Setting:United Kingdom.Materials and methods:The anatomical findings were collected from very recently published and well-edited books on neuroscience instead of hundreds of articles that contain materials still requiring test of time and difficult for busy clinicians to digest. Other individual references on specific issues such as a micturition centre, source of sildenafil citrate and so on are added. Clinical considerations discus commonly encountered problems of spinal cord injury service and science. Every clinical condition is discussed in conjunction with the anatomy and physiology of the RF.Results:This section involves anatomy. (1) The core RF is located in the brain stem. The RF proper is divided into three longitudinal zones: the lateral (sensory), the medial (motor) and the midline (all others) zone. The midline zone is essential for wakefulness and consciousness. (2) Other brain stem structures sharing functions of the RF proper: periaqueductal grey (PAG), red nuclei, inferior olivary nucleus and precerebellar nucleus. PAG is almost related to all functions of the central nervous system, whereas the others are more connected to cerebellar functions of movements. (3) Spinal cord RF is located in the intermediolateral zone. It sends ascending and receives descending signals to coordinate and modulate motor, sensory and other functions.Discussion:This section involves clinical consideration. Multisystem damage, muscle contraction, upper urinary tract, sexual behaviour, skin trophic, pain, sleep apnoea, cross-system damages, spinal cord repair and comprehensive management are discussed to enlighten the clinical importance of the RF.Spinal Cord (2009) 47, 204–212; doi:10.1038/sc.2008.105; published online 26 August 2008 [ABSTRACT FROM AUTHOR]

Study design:Literature review.Objectives:To present a comprehensive overview of autonomic assessment in experimental spinal cord injury (SCI).Methods:A systematic literature review was conducted using PubMed to extract studies that incorporated functional motor, sensory or autonomic assessment after experimental SCI.Results:While the total number of studies assessing functional outcomes of experimental SCI increased dramatically over the past 27 years, studies with motor outcomes dramatically outnumber those with autonomic outcomes. Within the areas of autonomic dysfunction (cardiovascular, respiratory, gastrointestinal, lower urinary tract, sexual function and thermoregulation), not all aspects have been characterized to the same extent. Studies focusing on bladder and cardiovascular function greatly outnumber those on sexual function, gastrointestinal function and thermoregulation. This review addresses the disparity between well-established motor-sensory testing presently used in experimental animals and the lack of standardized autonomic testing following experimental SCI. Throughout the review, we provide information on the correlation between existing experimental and clinically used autonomic tests. Finally, the review contains a comprehensive set of tables and illustrations to guide the reader through the complexity of autonomic assessment and dysfunctions observed following SCI.Conclusions:A wide variety of techniques exist to evaluate autonomic function in experimental animals with SCI. The incorporation of autonomic assessment as outcome measures in experiments testing treatments or interventions for SCI should be considered a high, clinically relevant priority.Spinal Cord (2009) 47, 2–35; doi:10.1038/sc.2008.61; published online 10 June 2008 [ABSTRACT FROM AUTHOR]

ObjectivesTo explore experiences of fatigue among people with spinal cord injuries (SCIs) and factors perceived to contribute to fatigue.SettingKelowna, Prince George, Vancouver and Victoria, British Columbia, Canada.Study designCollaborative, qualitative methodology.MethodsFour focus groups were undertaken simultaneously with a total of 29 participants, comprising a purposive sample of men and women: 21 people with complete and incomplete SCI of high and low tetraplegia and paraplegia, 2 family members, 2 assistants and 4 occupational therapists. Interpretive analysis was grounded in the themes identified in the data.ResultsFatigue was perceived to have cognitive, emotional and physical dimensions and to exert a profound effect on the lives of many people with SCI, such that pleasurable activities were often eschewed to enable the accomplishment of more mundane tasks. Factors most consistently associated with fatigue were pain, depression and hopelessness, side effects of medications, poor quality sleep, spasticity, poor posture, diet, and the effort required to accomplish routine and self-care tasks.ConclusionsFatigue is a complex phenomenon, interlinked with pain, depression and hopelessness that significantly diminishes the quality of life following SCI. Further research is required to provide greater understanding of this issue and to determine appropriate and comprehensive forms of intervention.Spinal Cord (2009) 47, 44–49; doi:10.1038/sc.2008.68; published online 10 June 2008 [ABSTRACT FROM AUTHOR]

Study design:A cross-sectional study of all patients with traumatic SCI admitted to Sunnaas Rehabilitation Hospital, Norway between 1961 and 1982.Objectives:To assess health-related quality of life (HRQOL) in persons with long-standing traumatic spinal cord injury (SCI) in Norway.Setting:Sunnaas Rehabilitation Hospital, Norway.Methods:Survey data and clinical examination of 165 persons with traumatic SCI of more than 20 years duration. HRQOL was assessed with the Norwegian 36-item short-form social functioning (SF-36) Health Survey. The SF-36 results were compared with Norwegian norm data adjusted to age and gender. Differences in HRQOL between subgroups were studied.Results:The persons with SCI exhibited significantly decreased HRQOL in the subscales for Physical Functioning, Bodily Pain, General Health and Vitality compared to the normal population. There were relatively small differences in HRQOL when comparing persons with paraplegia versus tetraplegia and persons with AIS (ASIA Impairment Scale; ASIA, American Spinal Injury Association) A–C versus D–E. Employed persons reported higher HRQOL compared to unemployed persons. HRQOL of individuals reporting health problems or symptoms was worse than those of individuals reporting no health problems at all.Conclusion:HRQOL is decreased in persons with long-standing SCI and especially in persons with comorbidity conditions.Spinal Cord (2008) 46, 710–715; doi:10.1038/sc.2008.17; published online 11 March 2008 [ABSTRACT FROM AUTHOR]

IntroductionOur aim was to ascertain what effect access to personal care package (PCP) has on the labour market activities of people who have a spinal cord injury (SCI). We developed a new instrument called the spinal injuries survey instrument (SISI). The SISI is a 35-item instrument, which contains items on health, education, employment, along with measures of personal assistance, mobility and psychological attribution style.Materials and methodsThe SISI was administered, with the Short Form 36 (SF-36) health status instrument, to 250 people with an SCI. The response rate was 72%. A retrospective, matched case-control sampling approach matched individuals who received a PCP, with a cohort who did not. The matching criteria included the site and severity of spinal lesion, age and gender.ResultsAlthough data on the reliability of the instrument are currently lacking, our empirical results are consistent with other studies: (1) mean annual health care costs (AUD$8741) are comparable with Walsh's estimates (2) SF-36 data support Kreuter's contention that mental health is resilient to SCI and (3) a post-injury employment rate of 29.7% corroborates Murphy et al. We present additional data describing income, educational attainment and family support.DiscussionOur discussion borrows a conceptualization of disability by Sen, that includes both an ‘earning handicap’ (an impediment to earn income) and a ‘conversion handicap’ (an impediment to the enjoyment of income). Our application of the SISI provides evidence of both. The labour income of people with quadriplegia is AUD$10 007 per annum, while diminished health status, increased out-of-pocket health expenditure and loss of time suggest a conversion handicap.Spinal Cord (2008) 46, 417–424; doi:10.1038/sj.sc.3102157; published online 8 January 2008 [ABSTRACT FROM AUTHOR]

Study Design:A basic study using a spinal cord injury (SCI) model in rats.Objectives:The effect of mild hypothermic treatment on histological changes and motor function after a rat spinal cord compression injury was assessed.Methods:Mild spinal cord compression was performed at the eleventh thoracic vertebral level by a 20 g weight for 20 min. Rats in the mild hypothermic model were kept at a body temperature of 33 °C and rats in the normothermic group were kept at 37 °C for 1 h from beginning of compression. Motor function was evaluated by measuring the frequency of standing. Microglia were stained by isolectin B4 and observed in the compressed portion of the spinal cord. The amount of tumor necrosis factor-α (TNF-α) in the compressed spinal cord was measured by the ELISA method.Results:In the normothermic rats, microglia proliferated up to 72 h after the compression. Proliferation was substantially inhibited at 48 and 72 h after compression in the hypothermic rats. The motor function of the hypothermic rats improved at 48 and 72 h after the compression, whereas no improvement was seen in the normothermic rats. The amount of TNF-α in the compressed portion of the spinal cord was lower in hypothermic rats compared with normothermic rats throughout the experiment.Conclusions:These results suggest that hypothermic treatment is effective for the amelioration of delayed motor dysfunction via inhibition of microglial inflammatory responses.Spinal Cord (2008) 46, 425–431; doi:10.1038/sj.sc.3102163; published online 4 March 2008 [ABSTRACT FROM AUTHOR]

Study Design:Postal survey.Objectives:To examine if the intensity of pain in persons with spinal cord injury (SCI) varied as a function of pain site, and to identify the patient and SCI characteristics associated with pain location, pain intensity and pain interference in a sample of persons with SCI.Setting:Community sample, United States.Methods:A postal survey including measures of pain intensity, pain interference, other pain, demographic and medical characteristics was completed by 238 adults with SCI.Results:Average pain intensity was moderate and pain was common across the body. Demographic and medical variables, including SCI level, were generally not associated with pain prevalence, intensity and interference. However, persons with higher level injuries were more likely to report upper extremity pain than persons with paraplegic injuries. The lower body was the location of the highest pain ratings.Conclusion:Persons with SCI tend to experience high pain intensity over multiple body locations. Lower body pain was as common as upper extremity pain, but tended to be more intense.Spinal Cord (2008) 46, 451–455; doi:10.1038/sc.2008.5; published online 19 February 2008 [ABSTRACT FROM AUTHOR]

Repair of the injured spinal cord by regeneration therapy remains an elusive goal. In contrast, progress in medical care and rehabilitation has resulted in improved health and function of persons with spinal cord injury (SCI). In the absence of a cure, raising the level of achievable function in mobility and self-care will first and foremost depend on creative use of the rapidly advancing technology that has been so widely applied in our society. Building on achievements in microelectronics, microprocessing and neuroscience, rehabilitation medicine scientists have succeeded in developing functional electrical stimulation (FES) systems that enable certain individuals with SCI to use their paralyzed hands, arms, trunk, legs and diaphragm for functional purposes and gain a degree of control over bladder and bowel evacuation. This review presents an overview of the progress made, describes the current challenges and suggests ways to improve further FES systems and make these more widely available.Spinal Cord (2008) 46, 255–274; doi:10.1038/sj.sc.3102091; published online 11 September 2007 [ABSTRACT FROM AUTHOR]

Study design:Cross-sectional, questionnaire.Objectives:Coping strategies employed to manage the consequences of a spinal cord lesion (SCL) have been found to be distinctly related to emotional well-being. However, research and clinical implications have been hampered by the lack of cross-validated measures that are directly related to the lesion and its consequences. This study investigates the psychometric performance of the SCL-related Coping Strategies Questionnaire in four different countries.Setting:Austria, Germany, Switzerland and UK.Methods:The study sample comprised 355 community residing persons with SCL. Multi-trait/multi-item analysis methods and non-parametric and parametric tests were used.Results:The Acceptance coping scale showed satisfactory psychometric qualities, whereas there were some problems in the Fighting spirit scale and greater problems in the Social reliance scale. Compared with the Swedish developmental sample, Acceptance was used more in the four study countries. Consistent with the original sample, Acceptance and Fighting spirit coping correlated with fewer signs of emotional distress, persons lesioned 5 years tended to report more Acceptance than the newly lesioned and coping strategies were mainly unrelated to neurological status.Conclusion:The English and German language versions of the Acceptance coping scale were valid and reliable, whereas some translated items in the Fighting spirit scale need to be revised. Translations of the Social reliance scale need to be thoroughly revised and retested. The results add further evidence to the literature on the stability of the link between adapting life priorities (ie Acceptance) and emotional well-being.Spinal Cord (2007) 45, 420–428; doi:10.1038/sj.sc.3102003; published online 19 December 2006 [ABSTRACT FROM AUTHOR]

Study design:In vitro studies using isolated guinea pig spinal cord white matter.Objectives:To determine whether lack of oxygen can cause irreversible impairment of electrical impulse conduction.Setting:Department of Basic Medical Sciences, Purdue University, West Lafayette, Indiana, USA.Methods:The hypoxic injury was induced by reducing the oxygen tension of the perfused solution by 80%. Compound action potentials (CAPs) were monitored before, during, and after oxygen deprivation.Results:We have found that 60 min of hypoxia reduced the conduction to 30% of preinjury level and recovered to approximately 60% of the preinjury level upon reoxygenation. Larger axons appeared to be more vulnerable to oxygen deprivation. We noted a significant decrease and recovery of the depolarizing afterpotential (DAP). Likewise, there was a delay and recovery of absolute and relative refractory period. Concomitantly, the ability of axons to follow repetitive stimuli was suppressed following oxygen deprivation but recovered upon reoxygenation.Conclusion:Following 60 min of oxygen deprivation and 30 min of reoxygenation, mammalian spinal cord white matter can partially recover electrical impulse conduction. However, within the same period, cords gained a complete recovery of other electrical properties, such as the depression of DAP, the delaying of refractory period, and the decreased ability to respond to repetitive stimuli. Compared to previous findings when both oxygen and glucose were deprived, we conclude that glucose plays a relatively minor role during the acute stage of oxygen deprivation in mammalian spinal cord white matter.Spinal Cord (2006) 44, 653–661. doi:10.1038/sj.sc.3101901; published online 24 January 2006 [ABSTRACT FROM AUTHOR]

Study design:Discussion and development of final consensus.Objective:Present the background, purpose, and process for the International Spinal Cord Injury (SCI) Data Sets development.Setting:International.Methods:An international meeting on SCI data collection and analysis occurred at a workshop on May 2, 2002, before the combined meeting of the American Spinal Injury Association (ASIA) and the International Spinal Cord Society (ISCoS) in Vancouver, British Columbia, Canada. At this meeting, a process was developed for selection of data elements to be included in International SCI Data Sets.Results:An overall structure and terminology has been developed following the format of the International Classification of Functioning, Disability and Health (ICF). This includes definitions of the Core Data Set, as well as Modules with Basic Questions or Data Sets and Expanded Data Sets. The Core Data Set has been developed and will be presented separately. Working groups for additional modules are being established as well as general guidelines for the development of the modules.Conclusion:The presented format should help in developing data sets and modules within various topics related to SCI.Spinal Cord (2006) 44, 530–534. doi:10.1038/sj.sc.3101930 [ABSTRACT FROM AUTHOR]

Study design:Survey of expert opinion, feedback, and development of final consensus.Objective:Present the background, purpose, development process, and results for the International Spinal Cord Injury (SCI) Core Data Set.Setting:International.Methods:A committee of experts was established to select and define data elements to be included in an International SCI Core Data Set. A draft core data set was developed and disseminated to appropriate organisations for comment. All suggested revisions were considered, and a final version of the core data set was disseminated again for approval and adoption.Results:The core data set consists of 24 variables, including basic demographic characteristics, dates of admission and discharge from initial acute and rehabilitation care, cause of injury, place of discharge, presence of vertebral fractures and associated injuries, occurrence of spinal surgery, and measures of neurological and ventilator status.Conclusion:Collection of the core data set should be a basic ingredient of all future studies of SCI to facilitate accurate description of patient populations and comparison of results across published studies from around the world.Spinal Cord (2006) 44, 535–540. doi:10.1038/sj.sc.3101958 [ABSTRACT FROM AUTHOR]

Study design:Determination of functional and biochemical parameters as well as the effect of specific therapies on these parameters, in the experimental model of neurotrauma in rabbits. Objective:To assess the effect of indomethacin (0.1-3.0 mg/kg for 9 days), a potent inhibitor of endogenous prostaglandin synthesis, on the motor activity and on the spinal cord tissue concentration of free palmitic, stearic, oleic, arachidonic and docosahexaenoic acids in an experimental model of a spinal cord injury in rabbits. Setting:Faculty of Medicine, University of Rijeka, Croatia. Methods:The animals were randomly divided into nine experimental groups, four sham and/or vehicle-treated and five indomethacin-treated (including one sham-operated and four injured groups). Laminectomy was followed by contusion of the spinal cord, using a modification of the technique of Albin. Motor activity was controlled daily during the course of the next nine postoperation days and scored using Tarlov's system. Spinal cord samples from the impact injury site were taken and frozen in liquid nitrogen. Total lipids were isolated and purified by a modification of the method of Folch. Free fatty acids (FFAs) were separated from the total lipid extract by preparative thin-layer chromatography, converted to the corresponding methyl esters and identified using gas chromatography, using nonadecanoic acid as the internal standard. Results:The concentrations of all analysed free fatty acids were increased in the spinal cord after neurotrauma, in comparison to control tissues. Treatment of injured rabbits with indomethacin resulted in a significant decrease in spinal cord FFAs and exerted a positive effect on neurotrauma-induced motor impairment. Conclusion:These results indicate a mechanism whereby indomethacin protects rabbits from the sequellae of neuronal damage caused by trauma, and suggests that it may be beneficial in the therapy of neurotrauma. [ABSTRACT FROM AUTHOR]

STUDY DESIGN::Prospective study. OBJECTIVE::To identify and define dermatological conditions following acute traumatic spinal cord injury (ATSCI) during inpatient rehabilitation. SETTING::Spinal Cord Injury Unit, The Department of Neurological Rehabilitation, The Chaim Sheba Medical Center, Israel. METHODS::During a 1-year study, all patients following ATSCI were prospectively studied for new dermatological findings during their inpatient rehabilitation. Every new dermatological finding was defined concerning its location with regard to the patient's neurological level, the time from injury to appearance and the exact dermatological diagnosis. RESULTS::During the study year, 46 ATSCI patients were hospitalized in our department, of whom were 38 (82.6%) males and eight (17.4%) females (mean age 30.2 years). A total of 21 (45.6%) patients were tetraplegic and 25 (54.3%) paraplegic. Of the patients, 28 (60.9%) had complete neurological injuries and 18 (39.1%) incomplete. In all, 14 (30.4%) patients developed a dermatological condition. There was no significant age or sex correlation to the development of these complications. There was a greater likelihood of paraplegia (48 versus 9.5%, P=0.005) and being neurologically complete (42.9 versus 11.1%, P=0.02). The dermatological findings appeared on an average of 80.3 days after the initial neurological insult. There were a total of 22 different dermatological findings: 11 (50%) were local fungal infections, two (9.1%) psoriatic lesions, two (9.1%) hyperkeratotic lesions, two (9.1%) bacterial infections (one folliculitis, one impetigo) and single cases of seborrheic dermatitis, acne, alopecia, scabies and allergic reaction. Of the findings, 14 (63.6%) were below the neurological level, including all of the fungal infections. CONCLUSIONS::Dermatological findings are common during rehabilitation of ATSCI. The clinical impact of these findings is low, but nevertheless, they are troublesome to the patient. The most common dermatological disorder was a local fungal infection below the neurological level. Paraplegic patients are more susceptible to the development of this condition. Patient and staff education regarding proper skin care may reduce these infections.Spinal Cord (2005) 43, 175-178. doi:10.1038/sj.sc.3101697 Published online 30 November 2004 [ABSTRACT FROM AUTHOR]

STUDY DESIGN::A cross-sectional survey with retrospective data. OBJECTIVE::Follow-up information on the use of mobility aids and transportation possibilities in a chronic traumatic spinal cord injury (SCI) population. SETTING::Clinic for Para- and Tetraplegia at Rigshospitalet, University hospital, Denmark (CPT). The uptake area is East Denmark with a population of 2.5 million inhabitants. METHODS::Survey on date of birth, gender, time of SCI, cause of SCI, neurological level and functional classification from medical files were combined with information concerning mobility aids and transport possibilities at the time of follow-up from a mailed questionnaire. MATERIAL::Individuals with traumatic SCI before 1 January 1991 were still in regular follow-up at CPT, and with sufficient medical record. A total of 279 were included, out of which 236 answered the questionnaire. Of the 193 men and 43 women injured from 1956 to 1990 the response rate was 84.6%. Age at the time of follow-up was 50.5 years in mean, and follow-up time was 24.1 years in mean. In all, 126 were paraplegic and 110 tetraplegic. Responders and nonresponders were comparable. RESULTS::In all, 3.4%used no special mobility aids at all. In total, 49 used crutches or rolling walkers and 26 lower extremities bracing, but mostly in combination with a wheelchair. Standing frame and stand-up wheelchair were used by men only. Manual wheelchair was used by 83.5%and electrical wheelchair by 27%, and the latter more by the tetraplegics. In all, 9.3%had neither a manual nor an electrical wheelchair. Overall, 86.4%had a passenger van or another car. Women used a car less often. Passenger vans were more often used by tetraplegics. CONCLUSION::Nearly all SCI participants had mobility aids of some sort, and 90.7%had either a manual or an electrical wheelchair or both. Most had a passenger van or another type of car for transportation. These facilities are important for the individuals to obtain an independent living.Spinal Cord (2004) 42, 699-706. doi:10.1038/sj.sc.3101649; Published online 3 August 2004 [ABSTRACT FROM AUTHOR]

Animal and human research have shown that the drug 4-aminopyridine (4-AP) may improve gait in spinal cord lesions by enhancing nerve transmission to affected muscles.STUDY DESIGN::Prospective, randomized, double-blind, placebo-controlled, crossover trial. OBJECTIVES::To determine the efficacy of 4-AP in improving lower limb muscle strength and biomechanical gait patterns of chronic spinal cord injuries (SCI). SETTING::The Rehabilitation Centre (Ottawa, Canada). METHODS::In all, 15 chronic, ambulatory SCI persons were randomized to an initial 2 weeks of 40?mg/day, oral medication of either placebo or immediate-release, 4-AP and subsequently crossed over to the alternate medication for the following 2 weeks. Evaluations were conducted at baseline (before starting 4-AP or placebo medication), 2 weeks, and 4 weeks. Measures included dynamometer lower limb isometric muscle force and biomechanical gait measures including temporal-spatial parameters, electromyographic activation patterns, joint kinematics and kinetics. Subjective impressions of the drug by the participants were obtained from an exit survey. RESULTS::Despite some positive comments from subjects, statistical and clinical analyses showed no within-subject differences between placebo and 4-AP measures of lower limb muscle force and objective gait analyses (ANOVA statistic P>0.05). CONCLUSION::Results demonstrated the importance of placebo-controlled trials and quantitative outcome measures for the evaluation of 4-AP aimed to enhance gait for chronic, ambulatory SCI persons. Energy expenditure measures and mood may relate more to subjective comments and is suggested for future investigations. SPONSORSHIP::American Paraplegia Society and the former American Paralysis Association.Spinal Cord (2004) 42, 674-685. doi:10.1038/sj.sc.3101653; Published online 7 September 2004 [ABSTRACT FROM AUTHOR]

OBJECTIVE::To investigate the impact of upper extremity deficit in subjects with tetraplegia. SETTING::The United Kingdom and The Netherlands. STUDY DESIGN::Survey among the members of the Dutch and UK Spinal Cord Injury (SCI) Associations. MAIN OUTCOME PARAMETER::Indication of expected improvement in quality of life (QOL) on a 5-point scale in relation to improvement in hand function and seven other SCI-related impairments. RESULTS::In all, 565 subjects with tetraplegia returned the questionnaire (overall response of 42%). Results in the Dutch and the UK group were comparable. A total of 77%of the tetraplegics expected an important or very important improvement in QOL if their hand function improved. This is comparable to their expectations with regard to improvement in bladder and bowel function. All other items were scored lower. CONCLUSION::This is the first study in which the impact of upper extremity impairment has been assessed in a large sample of tetraplegic subjects and compared to other SCI-related impairments that have a major impact on the life of subjects with SCI. The present study indicates a high impact as well as a high priority for improvement in hand function in tetraplegics.Spinal Cord (2004) 42, 526-532. doi:10.1038/sj.sc.3101638 Published online 29 June 2004 [ABSTRACT FROM AUTHOR]

Today, there is accumulating evidence from animal experiments that axonal regeneration and an enhanced level of functional repair can be induced after a spinal cord injury (SCI). Consequently, in the near future, new therapeutic approaches will be developed for the treatment of patients with SCI. The aim of the project presented here is to provide the required clinical basis for the implementation of novel interventional therapies. Refined and combined clinical and neurophysiological measures are needed for a precise qualitative and quantitative assessment of spinal cord function in patients with SCI at an early stage. This represents a basic requirement to recognise any improvement in the recovery of function and to monitor any significant effect of a new treatment. To this aim, five European Spinal Cord Injury Centres involved in the rehabilitation of acute SCI patients have built up a close clinical collaboration to develop a standardised protocol for the assessment of the outcome after SCI and the extent of recovery achieved by actually applied therapies in a larger population of SCI patients. The project's aim is to establish objective, refined tools as a basis for monitoring the effects of new treatment strategies.Spinal Cord (2004) 42, 1-6. doi:10.1038/sj.sc.3101558 [ABSTRACT FROM AUTHOR]

Study design:Case report.Objectives:To describe a child with intramedullary glioblastoma at T9–T10–T11, and to discuss the clinical features of this rare pathology.Setting:Department of Neurological Sciences, Italy.Case report:Spinal cord glioblastoma in children has only rarely been reported. It most frequently involves the thoracic region with a predilection for the second and third decades of life. This report describes one case of thoracic glioblastoma multiforme in a 6-year-old child and reviews other cases reported in the literature.Results:Laminectomy and excision of the tumour were performed. Postoperative radiotherapy and chemotherapy were given, but 4 months later the patient presented with a brain relapse of the tumour. At 9 months after diagnosis the patient died from cerebral tumour regrowth.Conclusions:Full neuraxis MRI is always recommended in order to detect possible metastases. The prognosis after multimodality therapy (surgery, radiotherapy, chemotherapy) remains poor. From the literature, only four cases of paediatric patients with long-term survival have been reported. [ABSTRACT FROM AUTHOR]

Introduces a series of articles which deals with spinal cord.