Clarifications of the Motor Level Definition in the International Standards for Neurological Classification of Spinal Cord Injury in Not Clinically Testable Myotomes.

Background: In the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), two approaches for determining motor levels (MLs) in not clinically testable myotomes (C2-C4, T2-L1, S2-S5) are described: one where the motor level follows the sensory level (MFSL) and another deriving motor function from sensory function (MFSF). Their results differ when (1) all key muscles of an upper (or upper and lower) extremity are scored as intact, (2) sensation is not normal in key muscle segments, and (3) a contiguous region of normal sensation starts at T2 (or S2).

Objectives: This work aims to characterize these cases and to discuss explanations.

Development and Validation of an Algorithm for Item Reduction of the International Standards for Neurological Classification of Spinal Cord Injury Examination to Determine Level and Severity of SCI.

Background: In 2020, a first, expedited version of the International Standards for Neurological Classification of Spinal Cord Injury (E-ISNCSCI-V1) was proposed for determination of neurological level of injury (NLI) and American Spinal Injury Association Impairment Scale (AIS) classifications.

Objectives: This work describes assessment of E-ISNCSCI-V1 classification accuracy and the development and data-based validation of an ISNCSCI Item Reduction Algorithm (IIRA).

Methods: Classification accuracy for E-ISNCSCI-V1 examination shortcut options was assessed with automated analysis of 7026 full ISNCSCI examinations.

International Standards for Neurological Classification of Spinal Cord Injury: Case Examples Reinforcing Concepts From the 2019 Revision.

Background: The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) is the most widely accepted system for characterizing sensorimotor impairments after spinal cord injury (SCI). There have been a number of ISNCSCI revisions, with the most recent edition published in 2019. Newer concepts, including the revised definitions of the zones of partial preservation (ZPPs) and documentation of non-SCI conditions, require training and practice for successful utilization.

International Standards for Neurological Classification of Spinal Cord Injury: Classification Questions and Cases.

Background: The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) have been refined through the years and continue to evolve with advances in the field. The International Standards Committee of the American Spinal Injury Association (ASIA) is responsible for maintaining, continually reviewing, and updating the ISNCSCI. Questions from spinal cord injury (SCI) professionals are frequently submitted to ASIA for review by the International Standards Committee.

Correlation of diaphragmatic ultrasound with pulmonary function testing in patients with chronic cervical spinal cord injury: A single center pilot study.

Context/objective: Pulmonary function tests are the gold standard of evaluating pulmonary function in individuals with a spinal cord injury (SCI). However, there are limitations to its accessibility thereby reducing its clinical utility. Diaphragmatic ultrasound is used to evaluate pulmonary function in non-neurologic individuals but there is limited evidence demonstrating its benefit in individuals with SCI.

Characteristics of Ipsilateral Corticomotor Pathways in People with cervical spinal cord Injury.

Objective: Understanding motor neurophysiology is important for developing effective upper limb treatments for people with tetraplegia following cervical spinal cord injury (SCI). While literature has primarily focused on contralateral motor pathways, neurophysiology of ipsilateral pathways remains largely unexplored in tetraplegia. We aimed to investigate ipsilateral physiology and its relationship to upper limb function in individuals with tetraplegia.

Assessing knowledge about the Americans with Disabilities Act and comfort level in treating persons with disabilities among fourth-year medical students following a clerkship in physical medicine and rehabilitation.

Background: All physicians will care for persons with disabilities over the course of their careers. However, most medical school curricula do not adequately prepare students to recognize and address the specific needs of persons with disabilities. Despite physician requirements under the Americans with Disabilities Act (ADA), patients with disabilities may receive substandard care due to a lack of accommodations.

Challenges and strategies for spinal cord injury research recruitment in rehabilitation hospitals: a single center perspective.

Study Design: A narrative review and perspective based on the experience of a single site in the U.S recruiting participants for clinical trials during the subacute phase (2 weeks to 3 months) following a traumatic spinal cord injury (SCI).

Objectives: To discuss challenges and propose strategies for enrolling individuals with SCI in research during the subacute phase within a comprehensive inpatient rehabilitation program.

Validity and Reliability of Interview and Online Self-Report Versions of Motor and Sensory Components of a Neurological Exam for Classifying Spinal Cord Injury (One-SCI).

Objective: To examine the feasibility, validity, and reliability of the Online Neurological Exam for Spinal Cord Injury (One-SCI), a patient-reported outcome measure of the motor and sensory components needed for classifying spinal cord injury (SCI) according to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI).

Design: Repeat administration (1wk interval) of either an online self-administered or an interviewer-administered survey (both supported by extensive computer-provided illustrations and animations) followed by an in-person ISNCSCI examination after an additional week.

Setting: Academic free standing rehabilitation center and medical center.

Development of Interview and Online Self-Report Versions of Motor and Sensory Components of a Neurological Exam for Classifying Spinal Cord Injury (One-SCI).

Objective: To develop a patient-reported outcome (PRO) survey measure of the motor, sensory, and anorectal components needed for classifying spinal cord injury (SCI) according to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI).

Design: Questionnaire development through an iterative process of review, feedback provision, and consensus revision incorporating 2 rounds of cognitive interviewing (CI).

Setting: Community.

Predicting Early Mortality in the Inpatient Cancer Rehabilitation Population Using Admission Performance Status Score.

Objective: To determine if a low admission Karnofsky Performance Scale (KPS) score is indicative of a higher likelihood of death within three months of discharge from inpatient rehabilitation with an active cancer diagnosis.

Design: A retrospective, observational design was employed to analyze electronic medical records of 385 patients with a primary or concurrent diagnosis of cancer admitted from a multi-center, acute inpatient rehabilitation hospital system between January 1, 2020, and December 31, 2020.

Results: Of the 385 patients, a total of 77 patients (20%) had an observed death within 3 months.

Sit-up test to assess orthostatic hypotension in individuals with spinal cord injury.

Aim: Individuals with spinal cord injury (SCI) have an increased prevalence of orthostatic hypotension (OH). Diagnosis of OH is made with active standing or tilt table testing, with limited the use in individuals with SCI.

Methods: An alternative approach to assess OH is the sit-up test, which involves passive repositioning from the supine to the seated position.

The Role of Motor Zones of Partial Preservation in Conversion From Initially Complete to Motor Incomplete Spinal Cord Injury.

Objective: To determine (1) the frequency of persons with spinal cord injury (SCI) presenting with a neurological complete injury (American Spinal Injury Association Impairment Scale [AIS] A) who would be classified as AIS C or D if sensory sacral sparing were present, and (2) if this status is associated with an increase in conversion to motor incomplete status on follow-up (6-24 months after injury).

Design: Retrospective analysis of longitudinal data.

Interventions: Not applicable.

PM&R Connections: A Pilot Study Evaluating the Adoptability and Impact of a Serious Educational Game on Trainees at a Physical Medicine and Rehabilitation Program.

To enhance engagement and educational outcomes, game-based learning has been introduced into undergraduate and graduate medical education programs. Using a free website, "PM&R Connections," a serious game, was created to provide trainees with an alternative method of reviewing content to identify knowledge gaps to direct studying. The game was used by 19/33 trainees and 92.

Clinical Subsets of Central Cord Syndrome: Is It a Distinct Entity from Other Forms of Incomplete Tetraplegia for Research?

Central cord syndrome (CCS) is the most prevalent and debated incomplete spinal cord injury (SCI) syndrome, with its hallmark feature being more pronounced weakness of the upper extremities than of the lower extremities. Varying definitions encapsulate multiple clinical features under the single umbrella term of CCS, complicating evaluation of its frequency, prognosis discussions, and outcomes research. Often, people with CCS are excluded from research protocols, as it is thought to have a favorable prognosis, but the vague nature of CCS raises doubts about the validity of this practice.

The Functional Implications of Transanal Irrigation: Insights from Pathophysiology and Clinical Studies of Neurogenic Bowel Dysfunction.

Defecation function is negatively impacted in patients with neurogenic bowel dysfunction (NBD), who require effective bowel care for stool evacuation. NBD comprises fecal incontinence and/or constipation, which can reduce the quality of life and dignity. Transanal irrigation (TAI) is recommended by several clinical guidelines as the second-line treatment after conservative treatment and before surgical options are considered.

Prevention, Diagnosis, and Management of Intraoperative Spinal Cord Injury in the Setting of Spine Surgery: A Proposed Care Pathway.

Study Design: This study is a mixed methods approach.

Objectives: Intraoperative spinal cord injury (ISCI) is a challenging complication in spine surgery. Intra-operative neuromonitoring (IONM) has been developed to detect changes in neural function.

An Update of a Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Role and Timing of Decompressive Surgery.

Study Design: Clinical practice guideline development.

Objectives: Acute spinal cord injury (SCI) can result in devastating motor, sensory, and autonomic impairment; loss of independence; and reduced quality of life. Preclinical evidence suggests that early decompression of the spinal cord may help to limit secondary injury, reduce damage to the neural tissue, and improve functional outcomes.

Corticospinal inhibition investigated in relation to upper extremity motor function in cervical spinal cord injury.

Objective: Corticospinal inhibitory mechanisms are relevant to functional recovery but remain poorly understood after spinal cord injury (SCI). Post-injury characteristics of contralateral silent period (CSP), a measure of corticospinal inhibition evaluated using transcranial magnetic stimulation (TMS), is inconsistent in literature. We envisioned that investigating CSP across muscles with varying degrees of weakness may be a reasonable approach to resolve inconsistencies and elucidate the relevance of corticospinal inhibition for upper extremity function following SCI.