TL;DR: The AIS replaced the modified Frankel scale and became the international gold standard for evaluation of spinal cord injuries, and improved reproducibility of the AIS and allowed for better understanding of the scale’s therapeutic and implications.
Abstract: There are approximately 12,500 spinal cord injuries in the US annually [15], with global incidence ranging from 133,000 to 226,000 cases annually [8]. The cost associated with spinal cord injuries is substantial, with estimates of the average lifetime cost of direct care ranging from USD 1.5 to 4.7 million [15]. Motor vehicles are the leading cause of injury, and are becoming an increasingly common cause in developing nations [15]. The demographics of patients with spinal cord injuries have broadened with time, however, males still account for 80% of new patients with spinal cord injuries [15]. The American Spinal Injury Association was created in 1973 to facilitate the exchange of research, data, and ideas among practitioners involved in the treatment of patients with spinal cord injuries. Its founders sought to establish a standardized model of care for the growing number of patients with spinal cord injuries. Before this, the Frankel scale had been developed to categorize spinal cord injuries [3]. However, the Frankel scale had considerable limitations. It did not specify the level of spine injury in its classification. It also did not define the difference between ‘motor useful’ and ‘motor useless’ grades, leading to subjective grading. [17]. In 1982, the American Spinal Injury Association published the International Standards for Neurological Classification of Spinal Injury [1], a grading and classification system that would evolve into the current American Spinal Injury Association Impairment Scale (AIS) [7]. Among its notable contributions, the International Standards for Neurological Classification of Spinal Injury classification helped identify key muscle groups and sensory points that improved practitioners’ precision at identifying neurologic levels of injury. In addition, it was a reproducible classification with detailed descriptions of each sensory and motor grade. This allowed accurate characterization of incomplete and complete spinal cord injuries [9]. The AIS replaced the modified Frankel scale and became the international gold standard for evaluation of spinal cord injuries [17]. Since its inception, the AIS has been revised multiple times as its authors continue to refine the steps of the neurologic examination and details of the classification grades. These revisions have improved reproducibility of the AIS and allowed for better understanding of the scale’s therapeutic and implications [17].
TL;DR: The use of neural progenitor cell transplants to restore connectivity in key neural systems following spinal damage is described and focused here on the use of neurons obtained or derived from different sources to promote connectivity in sensory, motor and autonomic systems.
Abstract: Spinal cord injury remains a scientific and therapeutic challenge with great cost to individuals and society. The goal of research in this field is to find a means of restoring lost function. Recently we have seen considerable progress in understanding the injury process and the capacity of CNS neurons to regenerate, as well as innovations in stem cell biology. This presents an opportunity to develop effective transplantation strategies to provide new neural cells to promote the formation of new neuronal networks and functional connectivity. Past and ongoing clinical studies have demonstrated the safety of cell therapy, and preclinical research has used models of spinal cord injury to better elucidate the underlying mechanisms through which donor cells interact with the host and thus increase long-term efficacy. While a variety of cell therapies have been explored, we focus here on the use of neural progenitor cells obtained or derived from different sources to promote connectivity in sensory, motor and autonomic systems.
TL;DR: It is imperative for the treating physicians to understand the complex underlying pathophysiological mechanisms of SCI, which has a complex and multifaceted mechanism.
Abstract: Spinal cord injury (SCI) is a life-shattering neurological condition that affects between 250,000 and 500,000 individuals each year with an estimated two to three million people worldwide living with an SCI-related disability. The incidence in the USA and Canada is more than that in other countries with motor vehicle accidents being the most common cause, while violence being most common in the developing nations. Its incidence is two- to fivefold higher in males, with a peak in younger adults. Apart from the economic burden associated with medical care costs, SCI predominantly affects a younger adult population. Therefore, the psychological impact of adaptation of an average healthy individual as a paraplegic or quadriplegic with bladder, bowel, or sexual dysfunction in their early life can be devastating. People with SCI are two to five times more likely to die prematurely, with worse survival rates in low- and middle-income countries. This devastating disorder has a complex and multifaceted mechanism. Recently, a lot of research has been published on the restoration of locomotor activity and the therapeutic strategies. Therefore, it is imperative for the treating physicians to understand the complex underlying pathophysiological mechanisms of SCI.
TL;DR: The International Collaborative Statement on Circulatory determination of death (cDCDD) as mentioned in this paper aims at expanding the use of circulatory determination for organ transplantation in the world to help countries progress towards self-sufficiency in transplantation and offer more patients the opportunity of organ donation.
Abstract: A decision to withdraw life-sustaining treatment (WLST) is derived by a conclusion that further treatment will not enable a patient to survive or will not produce a functional outcome with acceptable quality of life that the patient and the treating team regard as beneficial. Although many hospitalized patients die under such circumstances, controlled donation after the circulatory determination of death (cDCDD) programs have been developed only in a reduced number of countries. This International Collaborative Statement aims at expanding cDCDD in the world to help countries progress towards self-sufficiency in transplantation and offer more patients the opportunity of organ donation. The Statement addresses three fundamental aspects of the cDCDD pathway. First, it describes the process of determining a prognosis that justifies the WLST, a decision that should be prior to and independent of any consideration of organ donation and in which transplant professionals must not participate. Second, the Statement establishes the permanent cessation of circulation to the brain as the standard to determine death by circulatory criteria. Death may be declared after an elapsed observation period of 5 min without circulation to the brain, which confirms that the absence of circulation to the brain is permanent. Finally, the Statement highlights the value of perfusion repair for increasing the success of cDCDD organ transplantation. cDCDD protocols may utilize either in situ or ex situ perfusion consistent with the practice of each country. Methods to accomplish the in situ normothermic reperfusion of organs must preclude the restoration of brain perfusion to not invalidate the determination of death.
TL;DR: Over the past several years, the research field of spinal neuromodulation has generated promising results that hold potential to enable recovery of functions via epidural electrical stimulation (EES).
Abstract: Background Traumatic spinal cord injury (SCI) disrupts signaling pathways between the brain and spinal networks below the level of injury. In cases of severe SCI, permanent loss of sensorimotor and autonomic function can occur. The standard of care for severe SCI uses compensation strategies to maximize independence during activities of daily living while living with chronic SCI-related dysfunctions. Over the past several years, the research field of spinal neuromodulation has generated promising results that hold potential to enable recovery of functions via epidural electrical stimulation (EES). Methods This review provides a historical account of the translational research efforts that led to the emergence of EES of the spinal cord to enable intentional control of motor functions that were lost after SCI. We also highlight the major limitations associated with EES after SCI and propose future directions of spinal neuromodulation research. Results Multiple, independent studies have demonstrated return of motor function via EES in individuals with chronic SCI. These enabled motor functions include intentional, controlled movement of previously paralyzed extremities, independent standing and stepping, and increased grip strength. In addition, improvements in cardiovascular health, respiratory function, body composition, and urologic function have been reported. Conclusions EES holds promise to enable functions thought to be permanently lost due to SCI. However, EES is currently restricted to scientific investigation in humans with SCI and requires further validation of factors such as safety and efficacy before clinical translation.
TL;DR: Investigating the pathology and degree of clinical diagnosis and treatment strategies, the animal models that have allowed us to better understand this entity and the role of new diagnostic and prognostic tools such as miRNA could improve the ability to manage this pathological entity.
Abstract: Acute traumatic spinal cord injury (SCI) involves primary and secondary injury mechanisms. The primary mechanism is related to the initial traumatic damage caused by the damaging impact and this damage is irreversible. Secondary mechanisms, which begin as early as a few minutes after the initial trauma, include processes such as spinal cord ischemia, cellular excitotoxicity, ionic dysregulation, and free radical-mediated peroxidation. SCI is featured by different forms of injury, investigating the pathology and degree of clinical diagnosis and treatment strategies, the animal models that have allowed us to better understand this entity and, finally, the role of new diagnostic and prognostic tools such as miRNA could improve our ability to manage this pathological entity. Autopsy could benefit from improvements in miRNA research: the specificity and sensitivity of miRNAs could help physicians in determining the cause of death, besides the time of death.
42 citations
Cites background or methods from "Classifications In Brief: American ..."
...The anorectal sphincter function evaluation was definitively introduced [9]....
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...The motor examination consists of bilaterally evaluating, by means of a traditional six-step (0–5) strength evaluation scale with five specific muscle groups in the upper limbs and five specific muscle groups in the lower limbs; the cervical and lumbar myotomes are responsible for the movement of the 10 most important articulations [9]....
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...Although extremely accurate, the ASIA score present the major limitation of its substantial inapplicability for patients suffering from concurrent consciousness disturbances [9]....
TL;DR: The incidence of various types of fracture and fracture-dislocation and the degree of reduction achieved by postural reduction is analysed in relation to the initial and late neurological lesions.
Abstract: Six hundred and twelve patients with closed spinal injuries are described The incidence of various types of fracture and fracture-dislocation and the degree of reduction achieved by postural reduction is analysed in relation to the initial and late neurological lesions The average time that the patients were kept in bed is given for the various types of skeletal injury Only 4 patients developed late instability of the spine
TL;DR: International Standards for Neurological and Functional Classification of Spinal Cord Injury are published and will be used for clinical practice.
Abstract: International Standards for Neurological and Functional Classification of Spinal Cord Injury
TL;DR: The International Standards Booklet for Neurological and Functional Classification of Spinal Cord Injury (ISBWC) as mentioned in this paper is a standard for the classification of spinal cord injury. But it is not a classification of neurological disorders.
Abstract: The International Standards Booklet for Neurological and Functional Classification of Spinal Cord Injury
1,709 citations
"Classifications In Brief: American ..." refers background in this paper
...Inability to distinguish pinprick sensation from light touch is technically graded as 0 [11]....
TL;DR: The online global maps for traumatic spinal cord injury (TSCI) are updated and incorporate methods for extrapolating incidence data to inform an extrapolative statistical model, which estimates incidence for areas with insufficient TSCI data.
Abstract: Study design:Literature reviewObjectives:Update the global maps for traumatic spinal cord injury (TSCI) and incorporate methods for extrapolating incidence dataSetting:An initiative of the International Spinal Cord Society (ISCoS) Prevention CommitteeMethods:A search of Medline/Embase was performed (1959-Jun/30/2011) Enhancement of data-quality 'zones' including individual data-ranking as well as integrating regression techniques to provide a platform for continued regional and global estimatesResults:A global-incident rate (2007) is estimated at 23 TSCI cases per million (179 312 cases per annum) Regional data are available from North America (40 per million), Western Europe (16 per million) and Australia (15 per million) Extrapolated regional data are available for Asia-Central (25 per million), Asia-South (21 per million), Caribbean (19 per million), Latin America, Andean (19 per million), Latin America, Central (24 per million), Latin America-Southern (25 per million), Sub-Saharan Africa-Central (29 per million), Sub-Saharan Africa-East (21 per million)Discussion:It is estimated that globally in 2007, there would have been between 133 and 226 thousand incident cases of TSCI from accidents and violence The proportion of TSCI from land transport is decreasing/stable in developed but increasing in developing countries due to trends in transport mode (transition to motorised transport), poor infrastructure and regulatory challenges TSCIs from low falls in the elderly are increasing in developed countries with ageing populations In some developing countries low falls, resulting in TSCI occur while carrying heavy loads on the head in young people In developing countries high-falls feature, commonly from trees, balconies, flat roofs and construction sites TSCI is also due to crush-injuries, diving and violenceConclusion:The online global maps now inform an extrapolative statistical model, which estimates incidence for areas with insufficient TSCI data The accuracy of this methodology will be improved through the use of prospective, standardised-data registriesSpinal Cord advance online publication, 26 February 2013; doi:101038/sc2012158 Language: en
TL;DR: A reliable, validated prediction rule, including age and four neurological tests, can give an early prognosis of an individual's ability to walk after traumatic spinal cord injury, which can be used to set rehabilitation goals and might improve the ability to stratify patients in interventional trials.