Showing papers by "Ralph J. Marino published in 2016"
TL;DR: Little neurological recovery is seen in persons with complete thoracic SCI, especially with levels above T10, and Persons who are older at the time of injury have poorer functional recovery than younger persons.
Abstract: Objective: To describe neurological and functional outcomes after traumatic paraplegia.Design: Retrospective analysis of longitudinal database.Setting: Spinal Cord Injury Model Systems.Participants: Six hundred sixty-one subjects enrolled in the Spinal Cord Injury Model Systems database, injured between 2000 and 2011, with initial neurological level of injury from T2–12. Two hundred sixty-five subjects had second neurological exams and 400 subjects had Functional Independence Measure (FIM) scores ≥6 months after injury.Outcome Measures: American Spinal Injury Association Impairment Scale (AIS) grade, sensory level (SL), lower extremity motor scores (LEMS), and FIM.Results: At baseline, 73% of subjects were AIS A, and among them, 15.5% converted to motor incomplete. The mean SL increase for subjects with an AIS A grade was 0.33 ± 0.21; 86% remained within two levels of baseline. Subjects with low thoracic paraplegia (T10–12) demonstrated greater LEMS gain than high paraplegia (T2–9), and also had higher 1-...
45 citations
TL;DR: The RHI-ISNCSCI Algorithm provides a standardized method to accurately derive the level and severity of SCI from the raw data of the ISNC SCI examination.
Abstract: Validation study. To describe the development and validation of a computerized application of the international standards for neurological classification of spinal cord injury (ISNCSCI). Data from acute and rehabilitation care. The Rick Hansen Institute-ISNCSCI Algorithm (RHI-ISNCSCI Algorithm) was developed based on the 2011 version of the ISNCSCI and the 2013 version of the worksheet. International experts developed the design and logic with a focus on usability and features to standardize the correct classification of challenging cases. A five-phased process was used to develop and validate the algorithm. Discrepancies between the clinician-derived and algorithm-calculated results were reconciled. Phase one of the validation used 48 cases to develop the logic. Phase three used these and 15 additional cases for further logic development to classify cases with ‘Not testable’ values. For logic testing in phases two and four, 351 and 1998 cases from the Rick Hansen SCI Registry (RHSCIR), respectively, were used. Of 23 and 286 discrepant cases identified in phases two and four, 2 and 6 cases resulted in changes to the algorithm. Cross-validation of the algorithm in phase five using 108 new RHSCIR cases did not identify the need for any further changes, as all discrepancies were due to clinician errors. The web-based application and the algorithm code are freely available at www.isncscialgorithm.com
. The RHI-ISNCSCI Algorithm provides a standardized method to accurately derive the level and severity of SCI from the raw data of the ISNCSCI examination. The web interface assists in maximizing usability while minimizing the impact of human error in classifying SCI. This study is sponsored by the Rick Hansen Institute and supported by funding from Health Canada and Western Economic Diversification Canada.
39 citations
TL;DR: The components of initial and follow-up sacral sparing indicated differential patterns of neurologic outcome in persons with traumatic SCI and consideration of whether VAC should remain a diagnostic criterion sufficient for motor incomplete classification in the absence of other qualifying sublesional motor sparing is recommended.
31 citations
TL;DR: This study suggests that the greater torque achieved with low cadence cycling may result in improved bone health because of decreased bone turnover and improved trabecular bone microarchitecture.
29 citations
TL;DR: Compared with younger individuals, participants age ≥50 years with AIS grade B SCI are less likely to achieve walking function 1 year postinjury, and preservation of pinprick sensation postin injury in the majority of lower-extremity dermatomes L2-S1 increases the chances of walking in individuals age <50 years.
19 citations
TL;DR: S3 pressure sensation is reliable and has substantial agreement with DAP in persons with SCI at least 1 month postinjury, and is suggested as an alternative test of sensory sacral sparing for supraconus SCI, at least in cases where DAP cannot be tested.
17 citations
Boston University1, University of Delaware2, Northwestern University3, Rehabilitation Institute of Chicago4, Craig Hospital5, Rutgers University6, Kessler Foundation7, University of Louisville8, Thomas Jefferson University9, Spaulding Rehabilitation Hospital10, University of Michigan11, University of Pittsburgh12
TL;DR: Clinicians and researchers should consider using the SCI-FI/AT SFs to assess functioning with the use of assistive technology when CAT applications are not available.
14 citations
Toronto Western Hospital1, University of Maryland Medical Center2, University of Wisconsin-Madison3, University of Kansas4, Toronto Rehabilitation Institute5, National Defense Medical College6, University of California, Los Angeles7, University of Cambridge8, Thomas Jefferson University9, University of Toronto10, Thomas Jefferson University Hospital11, Kolling Institute of Medical Research12, Nagoya University13, University of Kansas Hospital14, Sunnybrook Health Sciences Centre15
6 citations
TL;DR: Recommendations for the optimal timing of decompression in patients with traumatic spinal cord injury and central cord syndrome are developed and suggest that early surgery be offered as an option for adult acute SCI patients regardless of level.
Abstract: The objective of this study is to develop guidelines that outline the optimal timing of decompression in patients with traumatic spinal cord injury (SCI) and central cord syndrome. A systematic review of the literature was conducted to address the following key questions: (1) What is the efficacy of early decompression (=24 hours) compared with late decompression (>24 hours) based on clinically important change in neurological status? (2) Does timing of decompression influence functional or administrative outcomes? (3) What is the safety profile of early decompression compared with late decompression? (4) What is the evidence that early decompression has differential efficacy or safety in subpopulations? (5) What is the comparative cost-effectiveness of early vs late decompression? A multidisciplinary guideline development group used this information, in combination with their clinical expertise, to develop recommendations for the optimal timing of SCI. The benefits and harms, financial impact, acceptability, feasibility, and patient preferences of each recommendation were carefully considered. The main conclusions from the systematic review included: (1) patients decompressed early were more likely to exhibit clinical improvement in neurological status at 6 months (cervical only) and at discharge from inpatient rehabilitation (all levels); (2) patients treated early for central cord syndrome achieved significantly greater improvements in neurological and functional status than those decompressed late; (3) there were no significant differences in length of acute care/rehabilitation stay or in rates of complications between treatment groups. Our recommendations included: "We suggest that early surgery be considered as a treatment option in adult patients with traumatic central cord syndrome" and "We suggest that early surgery be offered as an option for adult acute SCI patients regardless of level." These guidelines should be implemented into clinical practice to improve outcomes and reduce morbidity in patients with SCI by encouraging clinicians to make evidence-informed decisions.
6 citations
University of Toronto1, University of Maryland Medical Center2, University of Wisconsin-Madison3, University of Kansas4, Toronto Rehabilitation Institute5, National Defense Medical College6, Thomas Jefferson University7, University of California, Los Angeles8, Toronto Western Hospital9, University of Cambridge10, Thomas Jefferson University Hospital11, Kolling Institute of Medical Research12, Nagoya University13, University of Kansas Hospital14, Sunnybrook Health Sciences Centre15
TL;DR: Patients in the early cohort compared with 17% in the delayed cohort with the rate of mortality from all causes similar in both groups (4.1% vs 3.7%, P 1⁄4 .83).
3 citations
Thomas Jefferson University1, University of Toronto2, University of Maryland Medical Center3, University of Wisconsin-Madison4, University of Kansas5, Toronto Rehabilitation Institute6, National Defense Medical College7, University of California, Los Angeles8, Toronto Western Hospital9, University of Cambridge10, Thomas Jefferson University Hospital11, Kolling Institute of Medical Research12, Nagoya University13, University of Kansas Hospital14, Sunnybrook Health Sciences Centre15
Toronto Rehabilitation Institute1, University of Maryland Medical Center2, University of Wisconsin-Madison3, National Defense Medical College4, Thomas Jefferson University5, University of California, Los Angeles6, Toronto Western Hospital7, University of Cambridge8, University of Toronto9, Thomas Jefferson University Hospital10, Kolling Institute of Medical Research11, Nagoya University12, University of Kansas Hospital13, Sunnybrook Health Sciences Centre14