Association between deep vein thrombosis (DVT) and heterotopic ossification.
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Humans↗
Biomedical subjects
J F Ditunno
Publications and source records attributed to J F Ditunno.
Biceps vs extensor carpi radialis recovery in Frankel grades A and B in spinal cord injury patients.
Clinical literature suggests that the wrist extensors show a trend of achieving functional strength earlier than the biceps after spinal cord injury (SCI). Basic research, however, demonstrated that proximal muscles recover earlier than distal muscles after partial denervation. The purpose of this study was to compare biceps to extensor carpi radialis (ECR) recovery of muscle strength in 39 motor complete cervical SCI patients. Biceps (n = 19) and ECR (n = 20) with a 72 hour or 1 week motor grade of 1/5 were compared. Testing was performed weekly for 1 month, and again at 2, 3, 6 and 12 months post injury. The median recovery times to increase one motor grade were: biceps = 2 months and ECR = 2.5 months (p < 0.3). The median recovery times to increase two motor grades were: biceps = 2 months and ECR = 3 months (p < 0.4). In conclusion, there was no significant difference between the rates of recovery of the biceps and the ECR up to 12 months post SCI.
Adolescent↗
American spinal injury standards for neurological and functional classification of spinal cord injury: past, present and future. 1992 Heiner Sell Lecture of the American Spinal Injury Association.
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Disability Evaluation↗
Closed reduction of traumatic cervical spine dislocation using traction weights up to 140 pounds.
The purpose of this study was to demonstrate that Gardner-Wells skull tong traction up to 140 lb was both safe and effective in reducing dislocation, without fractures, of facet joints involving the C4-C7 vertebral bodies when applied by experienced practitioners in a spinal cord injury center under close scrutiny. Twenty-four awake patients were selected for the study (age range, 16-82 years). These patients were evaluated for the number of millimeters (7-17 mm) of dislocation as measured from the posterior aspect of the superior vertebral body to the posterior aspect of the inferior vertebral body at the level of injury. The maximum weight required to produce the reduction of the facet joints and the time from the onset of traction were recorded. The patients' neurologic status was monitored before traction, after each increment in weight applied, and after reduction. Careful examination of motor function and sensation was done and recorded at each interval. The 24 patients with cervical spine dislocation of the facet joints underwent successful reduction with traction weights (range, 10-140 lb). Seventeen patients required weights of more than 50 lb. The traction procedures lasted for a period of 8-187 minutes per procedure. Worsening neurologic status did not occur in any of the patients involved in this study.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Interinstitutional agreement of individual functional independence measure (FIM) items measured at two sites on one sample of SCI patients.
Individual items of the Functional Independence Measure (FIM) were analyzed for interinstitutional agreement using a sample of 57 spinal cord injured (SCI) patients at discharge from an acute care rehabilitation setting (ACRS) and at admission to an ongoing rehabilitation setting (ORS). The two FIM ratings were performed within 6 days of each other. The reliability coefficient for total FIM scores was good: 0.83. Individual items were classified into four groups: (1) above average reliability coefficient, above average proportion agreement, which included the feeding items and items from the mobility category; (2) above average reliability coefficient, below average agreement, which included the majority of items in the selfcare category; (3) below average reliability coefficient, above average agreement, which included items in the sphincter control and communication categories; and (4) below average reliability coefficient, below average agreement, which included items in the social cognition category. Patients received significantly higher ratings on most selfcare items in the ACRS, and significantly higher ratings on social cognition items in the ORS. Implications of these results are discussed in terms of using individual FIM items for research purposes. Reliability coefficients were acceptably high for subgroups of complete and incomplete paraplegics and for complete quadriplegics, ranging from 0.74 to 0.87, but low for incomplete quadriplegics, r = 0.49. However, these sample sizes were small, ranging from 9 to 17 patients. Data collection will continue in order to increase sample size and permit further analysis of these subgroups.
Disability Evaluation↗
Assessing selfcare status in quadriplegia: comparison of the quadriplegia index of function (QIF) and the functional independence measure (FIM).
The purpose of this study was to compare the quadriplegia index of function (QIF) to the functional independence measure (FIM) in assessing the daily performance of selfcare activities by individuals with cervical spinal cord injury. This study evaluated feeding, grooming and bathing activities in 22 C4-C7, Frankel A-D spinal cord injury patients between 3 and 12 months postinjury. The manual muscle test (MMT) was performed on 17 of these subjects during the same window of time as the QIF and the FIM. An upper extremity motor score (UEMS) was derived from the MMT. In order to relate motor power to functional ability, the UEMS was used as a measure of neurological function to test the hypothesis that the QIF scores are more highly correlated to motor power than are the FIM scores for this population. Spearman coefficients were calculated to correlate the QIF, the FIM and the UEMS. For the bathing and grooming categories, both the QIF and the FIM showed significant and similar correlations to the UEMS. For the feeding category, however, the QIF had a significantly better correlation to the UEMS than did the FIM (Rho = 0.90 vs 0.53, p < 0.01). Use of the QIF feeding scale may allow the detection of changes in function as individuals recover that the FIM scale would miss. Further evaluation of the remaining selfcare and mobility scales is needed. Modification of the FIM with more sensitive portions of the QIF would improve the discriminative ability of outcome studies and program evaluations.
Adolescent↗
Predicting recovery of motor complete quadriplegic patients. 24 hour v 72 hour motor index scores.
This paper reports motor index scores on motor complete (Frankel A, B), C4-T1, quadriplegic patients at admission, 72 h to 1 week and 6 months after spinal cord injury. This study is designed to test the hypothesis that the 72-h to 1-week motor index score (referred to as 72-h motor score) is superior to motor scores recorded within the first 24 h in predicting 6 month motor scores. Twenty-seven quadriplegic subjects, ages 15-70 years, were followed prospectively using manual muscle test to document motor recovery. Biceps, wrist extensors, triceps, flexor digitorum profoundus and first dorsal interossei were tested within 24 h, 72 h-1 week and 6 months after injury to comprise the motor index score. Average total motor scores for both upper extremities at admission were 14.0, at 72 h 13.9, and at 6 months 19.3 (ANOVA, P < 0.01). Total bilateral motor scores changed by 5.3 from admission to 6 months and by 5.4 from 72 h to 6 months. No significant difference existed between the admission and post 72-h motor score in predicting the 6-month motor score (Newmann-Keuls P > 0.05). Thus, despite significant change in motor score after spinal cord injury, both admission and 72-h motor scores equally predicted 6 month motor recovery of C4-T1 motor complete quadriplegic patients.
Adolescent↗
Pin sensation as a predictor of extensor carpi radialis recovery in spinal cord injury.
The purpose of this prospective study was to determine if initial preservation of C5 pin sensation could predict extensor carpi radialis (ECR) motor recovery in the zone of partial preservation after spinal cord injury (SCI). The study compared initial C5 pin sensation and initial ECR strength as predictors of ECR motor recovery after C4 and C5 SCI. The initial motor and sensory evaluation was done less than seven days after injury. Motor power was graded from absent (0/5) to normal strength (5/5). Pin sensation was graded as absent (0/2) decreased (1/2) or normal (2/2). The manual muscle test was performed weekly to four weeks and than at three, six, and 12 months after injury. An ECR muscle grade of > or = 3/5 was defined as recovery. C5 pin sensation at the lateral antecubital fossa significantly correlated with ECR recovery to > or = 3/5 (p < 0.001). Only two of nine subjects with absent C5 pin sensation recovered ECR to > or = 3/5, whereas 14 of 15 subjects with 1/2 or 2/2 C5 pin sensation had ECR motor recovery to > or = 3/5. All ten subjects with 1/5 or 2/5 initial ECR strength had ECR motor recovery. Five of six subjects with 0/5 initial ECR strength and subsequent ECR recovery to > or = 3/5 were found to have C5 pin preservation. In conclusion the presence of 1/5 to 2/5 initial ECR strength or 1/2 or 2/2 C5 pin sensation were highly significant predictors of ECR motor recovery to > or = 3/5 in C4 and C5 motor complete quadriplegic subjects.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Mechanical plus pharmacological prophylaxis for deep vein thrombosis in acute spinal cord injury.
This pilot study assessed the effectiveness of external pneumatic compression (EPC) with gradient elastic stockings (GES) and low dose heparin (LDH) in the prevention of deep vein thrombosis (DVT) in acute spinal cord injured (SCI) patients in the first 14 days following injury. Twenty-one consecutive patients within 48 hrs of injury with acute C2 through T12 motor complete or nonfunctional motor incomplete spinal cord lesions were enrolled. 125 I fibrinogen scanning was performed daily. A positive scan was confirmed by venography. Thrombosis was demonstrated in 1/19 patients. A control group from a previous study confirmed thrombosis in 6/17 patients (p = 0.04). Comparison of extent of thrombosis demonstrated a reduction in the treated group (p = 0.02). This pilot study demonstrates that EPC with GES plus LDH may be an effective prophylactic regimen in these patients.
Adolescent↗
Spinal cord injury: prognosis for ambulation based on quadriceps recovery.
The purpose of this study was to determine if early recovery of quadricep muscle strength post spinal cord injury (SCI) is a useful predictor of future ambulation. Seventeen C4-T10 motor incomplete (Frankel C) spinal cord injured patients admitted to our center between March 1988 and April 1990 were examined within 72 hours to one week post injury. All patients had initial quadricep strengths < or = 2/5 in both legs. Strength in the strongest quadricep was followed prospectively at intervals from admission to one year post injury. Recovery time to a > 3/5 quadricep was established for each patient. Patients were categorized into 2 groups: FA (n = 11) were those patients who achieved functional ambulation and NA (n = 6) were those subjects who were nonambulators. Functional ambulators were defined as those patients who were able to walk in the household and/or the community while non ambulators were those who either did not ambulate or did so only for exercise. All patients (n = 9) who achieved a > 3/5 quadricep by 2 months post SCI became functional ambulators whereas in the group of 8 patients who did not achieve a > 3/5 by 2 months, only 2 became functional ambulators. This result was found to be significant using a point-by-serial correlation with p < 0.05. In conclusion, motor incomplete spinal cord injured patients who recovered to a > 3/5 quadricep strength by 2 months post injury had an excellent prognosis for subsequent ambulation by 6 months post injury.
Adolescent↗
New spinal cord injury standards, 1992.
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Humans↗
Motor power differences within the first two weeks post-SCI in cervical spinal cord-injured quadriplegic subjects.
The purpose of this study was to confirm the clinical impression that motor power significantly changed within the first 2 weeks after a spinal cord injury (SCI) and to determine the time for motor power assessment within the first 2 weeks post injury that best correlated with motor power determined 6 months post-SCI. Our hypothesis was that within the first 2 weeks postinjury, the manual muscle test (MMT) scores would change significantly from the < or = 24 h examination and that the post-24 h evaluations of strength would have a higher correlation with the 6 month measure of motor outcome than the evaluation of strength performed < or = 24 h after SCI. The biceps, extensor carpi radialis, triceps, flexor digitorum profundus, and interosseous muscle strength was measured in 40 subjects using the MMT (muscles graded 0/5 to 5/5) at < or = 24 h, 72 h, 1 week, 2 weeks, 3 months, and 6 months post-SCI. Upper extremity motor index scores (MIS) obtained at the four testing periods within 2 weeks of injury were analyzed using a Friedman analysis of variance with Duncan's post-hoc tests to identify significant differences. Separate analyses were performed on subgroupings of the total sample based on the strength of the most rostral key muscle having less than antigravity strength. There were three groups evaluated: initial MMT 0/5 (n = 22), initial MMT 1-1.5/5 (n = 17), and initial MMT 2-2.5/5 (n = 13).(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Changes in nerve conduction and Pi/PCr ratio during denervation-reinnervation of the gastrocsoleus muscles of rats.
The purpose of this investigation was to study the changes in nerve conduction and phosphate metabolites of the gastrocsoleus muscles of rats during denervation-reinnervation. Sixteen male Sprague-Dawley rats underwent unilateral crush-denervation of the left sciatic nerves at the sciatic notch. Six rats were used for measurement of motor conduction latency and action potential amplitude of the gastrocsoleus muscle by stimulating the sciatic nerve at one, two and eight weeks after nerve crush. The other ten rats were designated for evaluation of the ratio of inorganic phosphorous (Pi) to phosphocreatine (PCr) by a 31P-phosphoenergetic spectrometer at two weeks and eight weeks after nerve crush. None of the sciatic nerves showed conduction to the gastrocsoleus at one or two weeks after nerve crush. At eight weeks postcrush, the motor conduction latency returned to within normal limits, whereas the action potential amplitude was only 55% of the normal. For the eight-week period of study, the Pi/PCr ratio of the normal control muscles ranged between 0.09 +/- 0.02 and 0.11 +/- 0.02 (mean +/- SD). The denervated muscles showed an increase of Pi/PCr ratio by 54% at two weeks postcrush, compared to the respective contralateral control sides. The ratios returned to the normal value by eight weeks postcrush. In summary, these data suggested that the metabolic recovery of the crush-denervated muscle followed the same pattern as the parameters of nerve conduction.
Animals↗
Extensor carpi radialis recovery predicted by qualitative SEP and clinical examination in quadriplegia.
This prospective study examined the efficacy of the qualitative somatosensory evoked potential (SEP) and the initial clinical neurologic evaluation to predict motor power recovery of the extensor carpi radialis muscle (ECR). Twenty three C5-6 Frankel A-D spinal cord injured (SCI) subjects had SEPs of the median nerve (MN) and superficial radial nerve (SRN) performed within 72 hours to one week post injury. The MN and SRN cortical SEPs were qualitatively graded as either present or absent. Fifteen subjects whose initial ECR muscle strength was less than or equal to 3/5 and eight subjects whose muscle strength was greater than 3/5 were followed up to 12 to 18 months post injury for improvement in ECR muscle strength. The subject's ECR strength was evaluated by manual muscle testing (MMT) at 72 hours, weekly for three weeks, monthly for three months, and then at six, 12, and 18 months. The pin sensation at the C-5 dermatome was also tested at the above intervals and graded as either present or absent. A one tail Fisher Exact test compared the presence or absence of the MN and SRN SEPs to the recovery of the ECR to 3/5. The same one tail test also compared the presence or absence of the 72 hour C-5 pin sensation and the 72 hour MMT to the ECR recovery. Among the 15 subjects with an initial MMT of less than or equal to 3/5, ten subjects had successful ECR recovery (greater than 3/5); 5 did not. The C-5 pin sensation correctly predicted ECR recovery in all subjects studied (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Motor recovery of the upper extremities in traumatic quadriplegia: a multicenter study.
Clinicians need to know recovery of neurologic function in the upper extremities after traumatic quadriplegia to prognosticate function in self-care, to determine the effectiveness of various interventions, and to develop a comprehensive rehabilitation plan. This study was undertaken to determine the extent of recovery of key muscles of the arms in motor complete quadriplegic subjects. The hypothesis stated that patients with some motor power (grades 1.0 to 2.5/5) in muscles in the zone of partial preservation would recover at an earlier time and to a greater extent than those with no motor power (grade 0/5). One hundred fifty subjects, C4, C5, and C6 motor complete, were entered in the study within one week of injury from four centers. Serial muscle examinations of the biceps, wrist extensors, and triceps on the right and left sides were performed up to 24 months after spinal cord injury. The pattern of recovery in the key muscles of the 67 subjects with some motor power in the zone of partial preservation to grade 3/5 was significantly greater than the 83 subjects with no motor power (68% to 82% vs 14% to 36%, p less than .001) at three to six months postinjury. The plateau of the median manual muscle test score determined the extent of recovery and reached grade 4/5 in subjects with some motor power at three to six months. The pattern of recovery revealed more subjects with some motor power improved to grade 3/5 at all intervals earlier than those with no motor power (p less than .005).(ABSTRACT TRUNCATED AT 250 WORDS)
Arm↗
Course of motor recovery in the zone of partial preservation in spinal cord injury.
Thirty-nine C4 to C6 motor complete Frankel A or B spinal cord injured subjects were included in this prospective study to determine the course of recovery in the zone of partial preservation (ZPP) during the first 6 months postinjury. Subjects had initial manual muscle testing and neurologic examination between 3 and 7 days postinjury. Subjects whose most rostral key muscle in the ZPP had a motor power of grade 1 or 1+/5 (group 1, n = 22) were compared with subjects whose most rostral key muscle had a motor power of grade 2 or 2+/5 (group 2, n = 17). Subjects had manual muscle testing weekly for 1 month and then monthly for 6 months postinjury. Comparisons were made for recovery to: (1) grade 3/5; (2) grade 4/5; (3) an increase of one grade; and (4) an increase of two grades. Analyses were made at monthly intervals by the Fisher Exact test and between median times of recovery by the Kruskal-Wallis Ranking test. There was earlier recovery to grade 3/5 for group 2. At one month 11 of 17 (65%) group 2 subjects had reached grade 3/5 compared with 4 of 22 (18%) group 1 subjects (p less than 0.01). At 2 months postinjury, 14 of 17 (82%) group 2 subjects versus 10 of 22 (45%) group 1 subjects had reached grade 3/5 strength (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Functional assessment measures in CNS trauma.
How effectively the survivor of CNS trauma can function in society is the ultimate clinical outcome. Many victims of spinal cord injury (SCI) and traumatic brain injury (TBI) are frequently left with permanent impairment. Measurements of impairment, and the direct relationship to the functional loss and resultant disability, should be the gold standard for determining the effectiveness of interventions. The primary impairments in SCI are motor and sensory loss while those in TBI are neurobehavioral disorders. Classifications for impairment are reasonably well defined in SCI and several approaches are gaining wide acceptance. We hope that internationally agreed upon standards will be forthcoming within the year. The functional independence measure (FIM), which was developed in the past 6-7 years, will be added to the standards. It shows good reliability for SCI as an overall assessment and some of the specific categories of self-care and mobility. An extension of the FIM is needed for more precise measurement of function in quadriplegic subjects. Classification of impairment in TBI has been more difficult. While the Glasgow Outcome Scale has gained international acceptance for almost 10 years, it has limitations in gradations from the moderate disability to the good recovery groups. The Disability Rating Scale (DRS) has shown good reliability, better precision than the Glasgow Outcome Scale, and greater reliability than other measures. An extension of the FIM, called the functional assessment measure (FAM), and the DRS are currently being tested by regional TBI centers in the United States. Functional assessment measures should be available within the next several years.
Brain Injuries↗
Sensory root level recovery in patients with Frankel A quadriplegia.
This prospective study was designed to demonstrate root level recovery of sensation in the zone of partial preservation in patients with C4 through C8, Frankel A spinal cord injuries. Subjects were evaluated for pin (n = 18) and light touch (n = 17) sensation. All subjects had normal sensation at the level of injury, and decreased or absent sensation at all levels caudal to that level within the zone of partial preservation; they had absent sensation at all levels below the zone of partial preservation. After the initial examination, patients were evaluated weekly for four weeks, and then at 2, 3, 6, 12, 18, and 24 months postinjury. Six of 18 patients recovered pin sensation and five of 17 recovered light touch within three months of injury. Most subjects who recovered had injuries from C5 through C8. Eleven of 12 C4 patients did not recover pin sensation, and 11 of 11 failed to recover light touch. However, five of six C5 to C8 patients recovered both pin and light touch. The p values (Fisher-Exact tests) for the C4 vs C5 to C8 groups were .004 and .001 for pin and light touch, respectively. In conclusion, approximately 30% of the total population improved one sensory root level, with the C5 to C8 injured patients comprising the majority of this improvement.
Humans↗