The graded redefined assessment of strength sensibility and prehension version 2 (GV2): Psychometric properties.

Context: GRASSP Version 1 (GV1) was developed in 2010, is an upper extremity measure specifically designed to assess recovery after traumatic tetraplegia. A second version was developed to reduce length of the test and refine instructions/standardization. The purpose of this post hoc analysis was to calculate psychometric properties of GRASSP Version 2 (GV2). Design/Setting: A post-hoc analysis of datasets for the GRASSP cross-sectional (n = 72 chronic,) and longitudinal (n = 127 acute) studies was conducted. Reliability, validity and MDD were calculated from the chronic sample and responsiveness was re-calculated from the longitudinal sample. Both studies were observational. Participants: A chronic sample (n = 72) and acute longitudinal sample (n = 127) of individuals with traumatic tetraplegia (AIS A to D, NLI C2 to C8) were studied. Outcome Measures: GV1, the Spinal Cord Independence Measure III (SCIM), International Standards of Neurological Classification of Spinal Cord Injury (ISNCSCI) were administered in both studies at all centers and the Capabilities of the Upper Extremity Questionnaire (CUE-Q) was administered in North American sites only. GRASSP-Palmar Sensation, GRASSP-Prehension Performance subtest items included in GV2 were re-analyzed for reliability; validity, MDD and responsiveness. Results: Inter-rater and test-retest reliability for all subtests ranged between 0.849-0.971 and 0.950-0.971 respectively. Concurrent validity between domains of GV2 were positively and moderately (0.530-0.830, P < 0.0001) correlated to SCIM, SCIM self-care subscore (SS) and CUE-Q. MDD values were 4 and 3 points for sensation and prehension performance (single side). Responsiveness values were .84-.88 for GR-Sens and .93-1.22 for GR-PP respectively. Conclusions: GV2 retains excellent psychometric properties as does GV1.

Assessment of posterior spinal cord function with electrical perception threshold in spinal cord injury.

The objective of this study was to evaluate the relevant sensory spinal pathways involved in conveying conduction of electrical perceptual threshold (EPT). In 34 individuals with cervical spinal cord injury (SCI) and eight healthy control subjects, combined EPT and electrical pain perception (EPP), and dermatomal somatosensory evoked potentials (dSSEP) from cervical dermatomes were examined. Stimulation intensities for EPT were recorded to determine quantitative sensory perception and related neurophysiological dSSEP interpretation of posterior spinal cord conduction based on onset latency and waveform configuration. The preservation of EPP in dermatomes was examined relative to EPT to dissociate the involvement of the posterior (dorsal horn and ascending dorsal column) and anterior (decussating and ascending spinothalamic fibers) spinal cord according to different nerve fiber recruitment in the periphery. Pathological EPT values were significantly (p < 0.05) accurate at predicting pathological and abolished dSSEP recordings (>80%), and the mean EPT of pathological and abolished dSSEPs was significantly (p < 0.05) increased compared to non-affected and control dSSEPs. dSSEPs demonstrated normal early onset latency at perceptually low stimulation intensities (<2.5 mA), and selectively absent EPP was dissociated from preserved EPT and/or dSSEP in 22.2% of dermatomes with incomplete sensory deficit. The relationship between EPT and dSSEP interpretation, dSSEP early onset latency and perceptual stimulation intensity, and the dissociation of EPT from EPP suggests that EPT is conducted within the posterior spinal cord. The combination of EPT and EPP with dSSEPs provides reliable quantitative sensory information to assess the segmental integrity of the posterior and anterior spinal cord, and may improve the sensitivity to monitor changes in sensory function after SCI.

Assessment of airway caliber and bronchodilator responsiveness in subjects with spinal cord injury.

STUDY OBJECTIVES: Previous spirometric findings among subjects with chronic tetraplegia that reduction in FEV1 and maximal forced expiratory flow, mid-expiratory phase (FEF(25-75%)) correlated with airway hyperresponsiveness to histamine, and that many of these subjects exhibited significant bronchodilator responsiveness, suggested that baseline airway caliber was low in this population. To better evaluate airway dynamics in patients with spinal cord injury, we used body plethysmography to determine specific airway conductance (sGaw), a less effort-dependent and more reflective surrogate marker of airway caliber. DESIGN: Cohort study. SETTING: Veterans Affairs medical center. PARTICIPANTS: Thirty clinically stable subjects with chronic spinal cord injury, including 15 subjects with tetraplegia (injury at C4-C7) and 15 subjects with low paraplegia (injury below T7), participated in the study. Fifteen able-bodied individuals served as a control group. INTERVENTIONS: Subjects underwent baseline assessment of spirometric and body plethysmographic parameters. Repeat measurements were performed among subjects with tetraplegia and paraplegia before and 30 min after receiving aerosolized ipratropium bromide (2.5 mL 0.02% solution; 12 subjects) or normal saline solution (2.5 mL; 6 subjects). MEASUREMENTS AND RESULTS: We found that subjects with tetraplegia had significantly reduced mean values for sGaw (0.16 cm H2O/s), total lung capacity, FVC, FEV1, and FEF(25-75%) compared to subjects in the other two groups. Subjects with tetraplegia who received ipratropium bromide experienced significant increases in sGaw (135%), FEV1 (12%; 260 mL), and FEF(25-75%) (27%). Significant, though far smaller, increases in sGaw (19%) were found among subjects with paraplegia. No discernable change in any pulmonary function parameter was found following the administration of normal saline solution. CONCLUSIONS: Subjects with tetraplegia, as opposed to those with low paraplegia, have reduced baseline airway caliber due to heightened vagomotor airway tone, which we hypothesize is the result of the interruption of sympathetic innervation to the lungs, and/or from low circulating epinephrine levels.

Neurographic assessment of intramedullary motoneurone lesions in cervical spinal cord injury: consequences for hand function.

Examination of hand function and neurography of the median- and ulnar nerves was performed in 15 patients with acute and 26 patients with chronic tetraplegia due to cervical spinal cord injury (SCI). 30% of patients showed a mild and 20% a severe axonal lesion of motor fibres of both nerves. The latter is caused by intramedullary damage of ventral horn cells and anterior nerve roots as neurographic examination of sensory nerve fibres was normal in these patients. The most frequent and severe nerve lesion was present in those with lower cervical spinal cord injuries (C6/7-Th1) where the median and ulnar nerves originate. In the latter patients the development of active hand function, which enables the patient to perform active grasping movements, was closely related to the result of neurography, already early after trauma. The results of median and ulnar neurography in tetraplegia due to cervical SCI allow to differentiate between intramedullary damage of motoneurones and the anterior nerve roots (peripheral nervous system) or the pyramidal tract fibres (central nervous system) within the spinal cord responsible for the paresis of the intrinsic hand muscles. Neurography is of prognostic value in cervical SCI to predict the outcome of hand function and therefore influences the appropriate occupational therapy and the program and aims of rehabilitation.