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Appendix D Tools to Assess Spinal Cord Injury Outcomes
Pages 260-267

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From page 260... ... Tools to Assess Spinal Cord Injury Outcomes Animal Functional recovery Basso, Beattie, and Bresnahan (BBB) scale, an open-field locomotor test for rats � Is based on 5-point Tarlov scale � Analyzes hind-limb movements of a rat in an open field � Is a 21-point scale used to assess locomotor coordination � Rates parameters such as joint movements, the ability for weight support, limb coordination, foot placement, and gait stability � Small changes in tissue correlate to large changes on the scale � Assesses walking, not other movements requiring coordinated spinal cord activity � Does not assess pain, bowel, bladder, or sexual function Basso Mouse Scale (BMS) Read the entire page →
From page 261... ... ; uses MEPs and SSEP (see below) � Looks at action potentials in muscle and nerves � Hard to assess minor but significant changes in locomotion � Does not assess pain, bowel, bladder, or sexual function Durham scale � Includes Tarlov scale, as well as functional task, bowel hygiene, and neck position � Is better than Tarlov scale at predicting spinal cord disorders � Hard to assess minor but significant changes in locomotion � Better suited for assessment of incomplete injuries � Does not assess pain, bowel, bladder, or sexual function Neuronal activity assessment by electrophysiology � Assesses MEPs or SSEP � Stimulates corresponding cortical areas of the brain and records response in target nerves to see if connections are still functional � Correlates to impairment of locomotor activity � Is noninvasive � Neuronal activity may not correlate with functional changes � Hard to assess subtle but critical improvements to circuitry � Does not directly assess pain, bowel, bladder, or sexual function Directed forepaw reaching � Looks at coordinated limb and muscle movement � Requires rats to reach under a barrier and pick up food with forepaws � Limited scale for assessment � Does not assess pain, bowel, bladder, or sexual function Grooming response � A little water is sprinkled on the head of a rat to elicit grooming with the rat's forelimbs and measure forelimb function � Is a brain stem-mediated spontaneous reflex sensitive to the level and severity of the injury � Looks only at forelimb response � Difficult to discriminate between loss of communication with brain stem or damage to other part of the nervous system Rearing � A rat is placed in a cylinder and is scored on how often it rears and simultaneously touches the walls of the cylinder with its forelimbs � Looks only at forelimb response Read the entire page →
From page 262... ... 262 SPINAL CORD INJURY: PROGRESS, PROMISE, AND PRIORITIES Tools to Assess Spinal Cord Injury Outcomes Walking speed � Is used to assess locomotor training techniques � Does not assess sensory modalities influenced by muscle strength � Does not assess pain, bowel, bladder, or sexual function Rotor rod � Is used to examine sensory feedback, coordination, and muscle strength required for locomotion � Is performed by placing the animal on a rotating bar and timing how long it takes for animal to lose balance � Only measures recovery of locomotion and does not assess restoration of fine motor control or other complications associated with spinal cord injury Inclined plane � Is used to examine sensory feedback, coordination, and muscle strength required for locomotion � Is performed by placing animal on a ramp of a preset incline � Only measures recovery of locomotion and does not assess restoration of fine motor control or other complications associated with spinal cord injury Footprint � Examines an animal's gait by analyzing paw position and toe drags � Only measures recovery of locomotion and does not assess restoration of fine motor control Grid walking � Tests the ability of mice and rats to walk over a wire mesh grid � Only investigates coordinated walking and not fine motor control Forepaw withdrawal � Investigates recovery of heat perception � The forepaw is placed on a heat block and the time that it takes for the animal to withdraw it is measured � Forepaw withdrawal requires motor function � Does not assess pain, bowel, bladder, or sexual function Assessment of autonomic dysreflexia � Changes in blood pressure are determined by comparing the animals baseline blood pressure and peak blood pressure during moderate cutaneous pinches to the skin rostral and caudal to the injury � Autonomic dysreflexia is also characterized in patients by sweating, flushed skin, and piloerection, which are not assessed in mouse model Morphological assessment of recovery Histology � Is used to look at the morphology of axons and assess the degree of tissue sparing, injury, and recovery Read the entire page →
From page 263... ... to E (the least severe) � Insensitive to small but significant changes in motor and sensory functions � May not be sensitive enough to detect even several spinal levels of regeneration in thoracic injuriesa � Does not specifically address functions that affect a patient's quality of life � Does not assess pain, bowel, bladder, or sexual function Includes: � ASIA Impairment Scale o Is based on the extent of injury and muscle strength o Uses an alphabetical score from A (the most severe) Read the entire page →
From page 264... ... � Scale measures functional limitations in walking of individuals after a spinal cord injury � Grades physical assistance and devices required for walking after paralysis of the lower extremities � Documents changes in functional capacity in respect to ambulation in a rehabilitation setting � Limited to assessment of walking Spinal Cord Injury-Functional Ambulation Inventory � Analyzes ambulation in individuals with spinal cord injuries relating to gait parameters, assistive device use, and temporal-distance measures � Limited to assessment of walking Barthel Index � Measures individual's independence in mobility � Assesses many deficits, including those after a stroke � Is designed to measure three categories of function: self-care, continence of bowel and bladder, and mobility � Functional ability can be a predictor of discharge from hospital � Floor and ceiling of scale are not sensitive enough to measure small but significant changes in function Read the entire page →
From page 265... ... � Measures voluntary movement and basic mobility � Is designed to be able to assess reemergence of voluntary movement and basic mobility � Assesses 30 mobility items, including upper and lower extremity mobility, using a 3- or 4-point scale � Can be used as a predictor of discharge from hospital Timed "up and go" (TUG) � Is considered the best test of functional mobility � The individual sits in a chair and is then required to stand and walk forward 3 meters � Requires patient to be able to walk Box and Block test � Is used to measure unilateral gross manual dexterity � The individual moves blocks, one by one, from one compartment to another in 60 seconds � Requires significant muscle strength and control Quantitative Sensory Testing (QST) Read the entire page →
From page 266... ... � Was designed by the World Health Organization to classify the consequences of disease and their implications on the patient's life � Defines impairment, disabilities, and handicaps � ICIDH-2 incorporates disability as a dynamic process and holds that environmental factors can influence the impairment Craig Handicap Assessment and Reporting Technique (CHART) � Is based on the World Health Organization model of handicap dimensions � Uses 27 questions and a 5-point scale to look at physical independence, economic self-sufficiency, social integration, mobility, and occupational functioning Needs Assessment Checklist (NAC) Read the entire page →
From page 267... ... � Provides a measure of community integration after a traumatic brain injury � Consists of 15 items relating to home integration, social integration, and productive activities Craig Hospital Inventory of Environmental Factors (CHIEF) � Is designed to assess the environmental factors and understand which elements of the environment impede or facilitate the lives of people with disabling conditions � Respondents use a 5-point scale to quantify the barriers experienced within five domains of environmental factors (policies, physical and structural, work and school, attitudes and support, services and assistance) Read the entire page →

From page 260...

... Tools to Assess Spinal Cord Injury Outcomes Animal Functional recovery Basso, Beattie, and Bresnahan (BBB) scale, an open-field locomotor test for rats � Is based on 5-point Tarlov scale � Analyzes hind-limb movements of a rat in an open field � Is a 21-point scale used to assess locomotor coordination � Rates parameters such as joint movements, the ability for weight support, limb coordination, foot placement, and gait stability � Small changes in tissue correlate to large changes on the scale � Assesses walking, not other movements requiring coordinated spinal cord activity � Does not assess pain, bowel, bladder, or sexual function Basso Mouse Scale (BMS)

Read the entire page →

From page 261...

... ; uses MEPs and SSEP (see below) � Looks at action potentials in muscle and nerves � Hard to assess minor but significant changes in locomotion � Does not assess pain, bowel, bladder, or sexual function Durham scale � Includes Tarlov scale, as well as functional task, bowel hygiene, and neck position � Is better than Tarlov scale at predicting spinal cord disorders � Hard to assess minor but significant changes in locomotion � Better suited for assessment of incomplete injuries � Does not assess pain, bowel, bladder, or sexual function Neuronal activity assessment by electrophysiology � Assesses MEPs or SSEP � Stimulates corresponding cortical areas of the brain and records response in target nerves to see if connections are still functional � Correlates to impairment of locomotor activity � Is noninvasive � Neuronal activity may not correlate with functional changes � Hard to assess subtle but critical improvements to circuitry � Does not directly assess pain, bowel, bladder, or sexual function Directed forepaw reaching � Looks at coordinated limb and muscle movement � Requires rats to reach under a barrier and pick up food with forepaws � Limited scale for assessment � Does not assess pain, bowel, bladder, or sexual function Grooming response � A little water is sprinkled on the head of a rat to elicit grooming with the rat's forelimbs and measure forelimb function � Is a brain stem-mediated spontaneous reflex sensitive to the level and severity of the injury � Looks only at forelimb response � Difficult to discriminate between loss of communication with brain stem or damage to other part of the nervous system Rearing � A rat is placed in a cylinder and is scored on how often it rears and simultaneously touches the walls of the cylinder with its forelimbs � Looks only at forelimb response

Read the entire page →

From page 262...

... 262 SPINAL CORD INJURY: PROGRESS, PROMISE, AND PRIORITIES Tools to Assess Spinal Cord Injury Outcomes Walking speed � Is used to assess locomotor training techniques � Does not assess sensory modalities influenced by muscle strength � Does not assess pain, bowel, bladder, or sexual function Rotor rod � Is used to examine sensory feedback, coordination, and muscle strength required for locomotion � Is performed by placing the animal on a rotating bar and timing how long it takes for animal to lose balance � Only measures recovery of locomotion and does not assess restoration of fine motor control or other complications associated with spinal cord injury Inclined plane � Is used to examine sensory feedback, coordination, and muscle strength required for locomotion � Is performed by placing animal on a ramp of a preset incline � Only measures recovery of locomotion and does not assess restoration of fine motor control or other complications associated with spinal cord injury Footprint � Examines an animal's gait by analyzing paw position and toe drags � Only measures recovery of locomotion and does not assess restoration of fine motor control Grid walking � Tests the ability of mice and rats to walk over a wire mesh grid � Only investigates coordinated walking and not fine motor control Forepaw withdrawal � Investigates recovery of heat perception � The forepaw is placed on a heat block and the time that it takes for the animal to withdraw it is measured � Forepaw withdrawal requires motor function � Does not assess pain, bowel, bladder, or sexual function Assessment of autonomic dysreflexia � Changes in blood pressure are determined by comparing the animals baseline blood pressure and peak blood pressure during moderate cutaneous pinches to the skin rostral and caudal to the injury � Autonomic dysreflexia is also characterized in patients by sweating, flushed skin, and piloerection, which are not assessed in mouse model Morphological assessment of recovery Histology � Is used to look at the morphology of axons and assess the degree of tissue sparing, injury, and recovery

Read the entire page →

From page 263...

... to E (the least severe) � Insensitive to small but significant changes in motor and sensory functions � May not be sensitive enough to detect even several spinal levels of regeneration in thoracic injuriesa � Does not specifically address functions that affect a patient's quality of life � Does not assess pain, bowel, bladder, or sexual function Includes: � ASIA Impairment Scale o Is based on the extent of injury and muscle strength o Uses an alphabetical score from A (the most severe)

Read the entire page →

From page 264...

... � Scale measures functional limitations in walking of individuals after a spinal cord injury � Grades physical assistance and devices required for walking after paralysis of the lower extremities � Documents changes in functional capacity in respect to ambulation in a rehabilitation setting � Limited to assessment of walking Spinal Cord Injury-Functional Ambulation Inventory � Analyzes ambulation in individuals with spinal cord injuries relating to gait parameters, assistive device use, and temporal-distance measures � Limited to assessment of walking Barthel Index � Measures individual's independence in mobility � Assesses many deficits, including those after a stroke � Is designed to measure three categories of function: self-care, continence of bowel and bladder, and mobility � Functional ability can be a predictor of discharge from hospital � Floor and ceiling of scale are not sensitive enough to measure small but significant changes in function

Read the entire page →

From page 265...

... � Measures voluntary movement and basic mobility � Is designed to be able to assess reemergence of voluntary movement and basic mobility � Assesses 30 mobility items, including upper and lower extremity mobility, using a 3- or 4-point scale � Can be used as a predictor of discharge from hospital Timed "up and go" (TUG) � Is considered the best test of functional mobility � The individual sits in a chair and is then required to stand and walk forward 3 meters � Requires patient to be able to walk Box and Block test � Is used to measure unilateral gross manual dexterity � The individual moves blocks, one by one, from one compartment to another in 60 seconds � Requires significant muscle strength and control Quantitative Sensory Testing (QST)

Read the entire page →

From page 266...

... � Was designed by the World Health Organization to classify the consequences of disease and their implications on the patient's life � Defines impairment, disabilities, and handicaps � ICIDH-2 incorporates disability as a dynamic process and holds that environmental factors can influence the impairment Craig Handicap Assessment and Reporting Technique (CHART) � Is based on the World Health Organization model of handicap dimensions � Uses 27 questions and a 5-point scale to look at physical independence, economic self-sufficiency, social integration, mobility, and occupational functioning Needs Assessment Checklist (NAC)

Read the entire page →

From page 267...

... � Provides a measure of community integration after a traumatic brain injury � Consists of 15 items relating to home integration, social integration, and productive activities Craig Hospital Inventory of Environmental Factors (CHIEF) � Is designed to assess the environmental factors and understand which elements of the environment impede or facilitate the lives of people with disabling conditions � Respondents use a 5-point scale to quantify the barriers experienced within five domains of environmental factors (policies, physical and structural, work and school, attitudes and support, services and assistance)

Read the entire page →

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Appendix D Tools to Assess Spinal Cord Injury Outcomes Pages 260-267

Appendix D Tools to Assess Spinal Cord Injury Outcomes
Pages 260-267