Is determination between complete and incomplete traumatic spinal cord injury clinically relevant? Validation of the ASIA sacral sparing criteria in a prospective cohort of 432 patients

Item does not contain fulltextSTUDY DESIGN: Prospective multicenter longitudinal cohort study. OBJECTIVE: To validate the prognostic value of the acute phase sacral sparing measurements with regard to chronic phase-independent ambulation in patients with traumatic spinal cord injury (SCI). SETTING: European Multicenter Study of Human Spinal Cord Injury (EM-SCI). METHODS: In 432 patients, acute phase (0-15 days) American Spinal Injury Association (ASIA)/International Spinal Cord Society neurological standard scale (AIS) grades, ASIA sacral sparing measurements, which are S4-5 light touch (LT), S4-5 pin prick (PP), anal sensation and voluntary anal contraction; and chronic phase (6 or 12 months) indoor mobility Spinal Cord Independence Measure (SCIM) measurements were analyzed. Calculations of positive and negative predictive values (PPV/NPV) as well as univariate and multivariate logistic regressions were performed in all four sacral sparing criteria. The area under the receiver-operating characteristic curve (AUC) ratios of all regression equations was calculated. RESULTS: To achieve independent ambulation 1-year post injury, a normal S4-5 PP score showed the best PPV (96.5%, P<0.001, 95% confidence interval (95% CI): 87.9-99.6). Best NPV was reported in the S4-5 LT score (91.7%, P<0.001, 95% CI: 81.6-97.2). The use of the combination of only voluntary anal contraction and the S4-5 LT and PP sensory scores (AUC: 0.906, P<0.001, 95% CI: 0.871-0.941) showed significantly better (P<0.001, 95% CI: 0.038-0.128) discriminating results in prognosticating 1-year independent ambulation than with the use of currently used distinction between complete and incomplete SCI (AUC: 0.823, P<0.001, 95% CI: 0.781-0.864). CONCLUSIONS: Out of the four sacral sparing criteria, the acute phase anal sensory score measurements do not contribute significantly to the prognosis of independent ambulation. The combination of the acute phase voluntary anal contraction and the S4-5 LT and PP scores, predicts significantly better chronic phase-independent ambulation outcomes than the currently used distinction between complete and incomplete SCI. SPONSORSHIP: This study was granted by 'Acute Zorgregio Oost' and the 'Internationale Stiftung fur Forschung in Paraplegie (IFP)'

Bone mineral density in elite adolescent female figure skaters

<p>Abstract</p> <p>Elite adolescent figure skaters must accommodate both the physical demands of competitive training and the accelerated rate of bone growth that is associated with adolescence, in this sport that emphasizes leanness. Although, these athletes apparently have sufficient osteogenic stimuli to mitigate the effects of possible low energy availability on bone health, the extent or magnitude of bone accrual also varies with training effects, which differ among skater disciplines.</p> <p>Purpose</p> <p>We studied differences in total and regional bone mineral density in 36 nationally ranked skaters among 3 skater disciplines: single, pairs, and dancers.</p> <p>Methods</p> <p>Bone mineral density (BMD) of the total body and its regions was measured by dual energy x-ray absorptiometry (DXA). Values for total body, spine, pelvis and leg were entered into a statistical mixed regression model to identify the effect of skater discipline on bone mineralization while controlling for energy, vitamin D, and calcium intake.</p> <p>Results</p> <p>The skaters had a mean body mass index of 19.8 ± 2.1 and % fat mass of 19.2 ± 5.8. After controlling for dietary intakes of energy, calcium, and vitamin D, there was a significant relationship between skater discipline and BMD (p = 0.002), with single skaters having greater BMD in the total body, legs, and pelvis than ice dancers (p < 0.001). Pair skaters had greater pelvic BMD than ice dancers (p = 0.001).</p> <p>Conclusions</p> <p>Single and pair skaters have greater BMD than ice dancers. The osteogenic effect of physical training is most apparent in single skaters, particularly in the bone loading sites of the leg and pelvis.</p

Predicting task performance from upper extremity impairment measures after cervical spinal cord injury

BACKGROUND Automated sensor-based assessments of upper extremity (UE) function after cervical spinal cord injury (SCI) could provide more detailed tracking of individual recovery profiles than is possible with existing assessments, and optimize the delivery and assessment of new interventions. The design of reliable automated assessments requires identifying the key variables that need to be measured to meaningfully quantify UE function. An unanswered question is to what extent measures of sensorimotor impairment can quantitatively predict performance on functional tasks. OBJECTIVE The objective was to define the predictive value of impairment measures for concurrent functional task performance in traumatic cervical SCI, as measured by the Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP). SETTING Retrospective analysis. METHODS A data set of 138 GRASSP assessments was analyzed. The Strength and Sensation modules were used as measures of impairment, whereas the concurrent Prehension Performance module was used as the surrogate measure of function. Classifiers were trained to predict the scores on each of the six individual tasks in the Prehension Performance module. The six scores were added to obtain a total score. RESULTS The Spearman's ρ between predicted and actual total Prehension Performance scores was 0.84. Predictions using both the Strength and Sensation scores were not found to be superior to predictions using the Strength scores alone. CONCLUSIONS Measures of UE motor impairment are highly predictive of functional task performance after cervical SCI. Automated sensor-based assessments of UE motor function after SCI can rely on measuring only impairment and estimating functional performance accordingly.Spinal Cord advance online publication, 31 May 2016; doi:10.1038/sc.2016.77