Journal of neurotrauma
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Journal of neurotrauma · Mar 2012
Multicenter Study Clinical TrialThe Graded Redefined Assessment of Strength Sensibility and Prehension: reliability and validity.
With the advent of new interventions targeted at both acute and chronic spinal cord injury (SCI), it is critical that techniques and protocols are developed that reliably evaluate changes in upper limb impairment/function. The Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP) protocol, which includes five subtests, is a quantitative clinical upper limb impairment measure designed for use in acute and chronic cervical SCI. The objectives of this study were to: (1) establish the inter-rater and test-retest reliability, and (2) establish the construct and concurrent validity with the International Standards of Neurological Classification of Spinal Cord Injury (ISNCSCI), Spinal Cord Independence Measure II (SCIM), and the Capabilities of Upper Extremity Questionnaire (CUE). ⋯ The GRASSP is about 50% more sensitive (construct validity) than the ISNCSCI when defining sensory and motor integrity of the upper limb; the subtests showed concurrence with the SCIM, SCIM self-care subscale, and CUE. The strongest concurrence to impairment was with self-perception of function (CUE) (0.57-0.83, p<0.0001). The GRASSP was found to demonstrate reliability, construct validity, and concurrent validity for use as a standardized upper limb impairment measure for individuals with tetraplegia.
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Journal of neurotrauma · Mar 2012
Rapamycin promotes autophagy and reduces neural tissue damage and locomotor impairment after spinal cord injury in mice.
The mammalian target of rapamycin (mTOR) is a serine/threonine kinase that negatively regulates autophagy. Rapamycin, an inhibitor of mTOR signaling, can promote autophagy and exert neuroprotective effects in several diseases of the central nervous system (CNS). In the present study, we examined whether rapamycin treatment promotes autophagy and reduces neural tissue damage and locomotor impairment after spinal cord injury (SCI) in mice. ⋯ These results indicate that rapamycin promoted autophagy by inhibiting the mTOR signaling pathway, and reduced neural tissue damage and locomotor impairment after SCI. The administration of rapamycin produced a neuroprotective function at the lesion site following SCI. Rapamycin treatment may represent a novel therapeutic strategy after SCI.
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Journal of neurotrauma · Mar 2012
ReviewA systematic review of the effects of pharmacological agents on walking function in people with spinal cord injury.
Studies of spinalized animals indicate that some pharmacological agents may act on receptors in the spinal cord, helping to produce coordinated locomotor movement. Other drugs may help to ameliorate the neuropathological changes resulting from spinal cord injury (SCI), such as spasticity or demyelination, to improve walking. The purpose of this study was to systematically review the effects of pharmacological agents on gait in people with SCI. ⋯ Two Level 5 studies showed that baclofen had little to no effect on improving walking in persons with incomplete SCI. There is limited evidence that pharmacological agents tested so far would facilitate the recovery of walking after SCI. More studies are needed to better understand the effects of drugs combined with gait training on walking outcomes in people with SCI.
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Journal of neurotrauma · Mar 2012
Impact of GOS misclassification on ordinal outcome analysis of traumatic brain injury clinical trials.
This study extends our previous investigation regarding the effect of nondifferential dichotomous Glasgow Outcome Scale (GOS) misclassification in traumatic brain injury (TBI) clinical trials to the effect of GOS misclassification on ordinal analysis in TBI clinical trials. The impact of GOS misclassification and ordinal outcome analysis was explored via probabilistic sensitivity analyses using TBI patient datasets from the IMPACT database (n = 9205). Three patterns of misclassification were explored given the pre-specified misclassification distributions. ⋯ Thus the sensitivity analysis suggests that the nondifferential misclassification can cause uncertainties on the primary outcome estimation in TBI trials. However, such an effect is likely to be small when ordinal analysis is applied, compared with the impact of dichotomous GOS misclassifications. The result underlines that the ordinal GOS analysis may gain from both statistical efficiency, as suggested by several recent studies, and a relatively smaller impact from misclassification as compared with conventional binary GOS analysis.