Revisiting the Examination of Sharp/Dull Discrimination as Clinical Measure of Spinothalamic Tract Integrity

Objective: Revisiting the sharp/dull discrimination as clinical measure of spinothalamic tract function considering the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). Three clinically relevant factors were evaluated as to their impact on reliability: (1) the localization of dermatomes in relation to the sensory level, (2) the examination tool, and (3) the threshold of correct answers for grading of a preserved sharp/dull discrimination.Design: Prospective monocentric psychometric study.Setting: Spinal Cord Injury Center, Heidelberg University Hospital, Germany.Participants: Convenient sample of 21 individuals with subacute spinal cord injury (age: 31–82 years) and 20 individuals without spinal cord injury (age: 24–63 years).Assessment: All participants underwent three assessments for sharp/dull discrimination, applying five commonly used examination tools in seven dermatomes, performed by three trained examiners under conditions in accordance with ISNCSCI.Main Outcome Measures: Assessment of interrater reliability by determining both the Fleiss kappa (κ) coefficient and the percentage agreement between raters. Data were dichotomized regarding the ISNCSCI threshold.Results: Interrater reliability in individuals with SCI was overall substantial (κ = 0.68; CI 0.679–0.681) and moderate (κ = 0.54; CI 0.539–0.543) in dermatomes below the sensory level. All applied tools led to at least moderate reliability below the sensory level (lowest κ = 0.44; CI 0.432–0.440), with the officially endorsed safety pin achieving the highest (substantial) reliability (κ = 0.64; CI 0.638–0.646). Percentage agreement differed between non-SCI (97.3%) and formally intact above level dermatomes in SCI (89.2%).Conclusions: Sharp/dull discrimination as a common clinical examination technique for spinothalamic tract function is a reliable assessment. Independent from the used examination tools, reliability was substantial, with the medium-sized safety pin delivering the most favorable results. Notwithstanding this, all other tools could be considered if a safety pin is not available. Regarding interrater reliability and guessing probability, a threshold of 80% correct responses for preserved sharp/dull discrimination appears to be most suitable, which is in line with current clinical approaches and ISNCSCI. The causal attribution of the identified differences in sharp/dull discrimination between clinically intact dermatomes of individuals with SCI and unaffected dermatomes of individuals without SCI requires future work.Clinical Trial Registration Number (German Clinical Trials Register): DRKS00015334 (https://www.drks.de).

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Interrater Reliability of the Pediatric Neuromuscular Recovery Scale for Spinal Cord Injury

Topics in Spinal Cord Injury Rehabilitation ◽

10.1310/sci2502-121 ◽

2019 ◽

Vol 25 (2) ◽

pp. 121-131 ◽

Cited By ~ 1

Author(s):

Andrea L. Behrman ◽

Shelley A. Trimble ◽

Laura C. Argetsinger ◽

MacKenzie T. Roberts ◽

MJ Mulcahey ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Interrater Reliability ◽

Cord Injury

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313 DISCOMPLETE LESIONS OF THE SPINOTHALAMIC TRACT PREDICT THE PRESENCE OF NEUROPATHIC PAIN FOLLOWING SPINAL CORD INJURY

European Journal of Pain ◽

10.1016/j.ejpain.2007.03.328 ◽

2007 ◽

Vol 11 (S1) ◽

pp. S138-S139

Author(s):

G. Wasner

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Neuropathic Pain ◽

Spinothalamic Tract ◽

Cord Injury

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Quantitative testing in spinal cord injury: overview of reliability and predictive validity

Journal of Neurosurgery Spine ◽

10.3171/2012.5.aospine1296 ◽

2012 ◽

Vol 17 (Suppl1) ◽

pp. 141-150 ◽

Cited By ~ 16

Author(s):

Maxwell Boakye ◽

Susan Harkema ◽

Peter H. Ellaway ◽

Andrea C. Skelly

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Evoked Potentials ◽

Predictive Validity ◽

Correlation Coefficients ◽

Sensory Level ◽

Intrarater Reliability ◽

Interclass Correlation ◽

Cord Injury

Object The objective of this study was to identify commonly used physiological outcome measures and summarize evidence on the reliability and predictive validity of quantitative measures used in monitoring persons with spinal cord injury (SCI). Methods A systematic search of PubMed through January 5, 2012, was conducted to identify publications using common outcome measures in persons with SCI and for studies that were specifically designed to evaluate the reliability and predictive validity of selected quantitative measures. Quantitative measures were defined as tests that quantify sensory and motor function, such as amount of force or torque, as well as thresholds, amplitudes, and latencies of evoked potentials that might be useful in studies and monitoring of patients with SCI. Reliability studies reporting interclass correlation coefficients (ICCs) or weighted κ coefficients were considered for inclusion. Studies explicitly evaluating correlation between measures and specific functional outcomes were considered for predictive validity. Results From a total of 121 potentially relevant citations, 6 studies of reliability and 4 studies of predictive validity for quantitative tests met the inclusion criteria. In persons with incomplete SCI, ICCs for both interrater and intrarater reliability of electrical perceptual threshold (EPT) were ≥ 0.7 above the sensory level of SCI but were less reliable below the sensory level. Interclass correlation coefficients for interrater and intrarater reliability of the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP) components ranged from 0.84 to 0.98. For electromyography, the ICC was consistently high for within-day tests. The overall quality of reliability of the majority of studies was poor, due to the potential for selection bias and small sample sizes. No classic validation studies were found for the selected measures, and evidence regarding the predictive validity of the measures was limited. Somatosensory evoked potentials (SSEPs) may be correlated with ambulatory capacity, as well as the Barthel Index and motor index scores, but this correlation was limited for evaluation of bladder function recovery in 3 studies that assessed the correlation between baseline or initial SSEPs and a specific clinical outcome at a later follow-up time. All studies used convenience samples and the overall sample quality was low. Conclusions Evidence on the reliability and validity of the quantitative measures selected for this review is limited, and the overall quality of existing studies is poor. There is some evidence for the reliability of the EPT, dermatomal SSEPs, and the GRASSP to suggest that they may be useful in longitudinal studies of patients with SCI. There is a need for high quality studies of reliability, responsiveness, and validity for quantitative measures to monitor the level and degree of SCI.

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Effects of exercise training on urinary tract function after spinal cord injury

AJP Renal Physiology ◽

10.1152/ajprenal.00557.2015 ◽

2016 ◽

Vol 310 (11) ◽

pp. F1258-F1268 ◽

Cited By ~ 12

Author(s):

Charles H. Hubscher ◽

Lynnette R. Montgomery ◽

Jason D. Fell ◽

James E. Armstrong ◽

Pradeepa Poudyal ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Urinary Tract ◽

Exercise Training ◽

Kidney Tissue ◽

Sensory Information ◽

Cord Injury ◽

Tract Function ◽

Underlying Mechanisms ◽

The Impact

Spinal cord injury (SCI) causes dramatic changes in the quality of life, including coping with bladder dysfunction which requires repeated daily and nightly catheterizations. Our laboratory has recently demonstrated in a rat SCI model that repetitive sensory information generated through task-specific stepping and/or loading can improve nonlocomotor functions, including bladder function (Ward PJ, Herrity AN, Smith RR, Willhite A, Harrison BJ, Petruska JC, Harkema SJ, Hubscher CH. J Neurotrauma 31: 819–833, 2014). To target potential underlying mechanisms, the current study included a forelimb-only exercise group to ascertain whether improvements may be attributed to general activity effects that impact target organ-neural interactions or to plasticity of the lumbosacral circuitry that receives convergent somatovisceral inputs. Male Wistar rats received a T9 contusion injury and were randomly assigned to three groups 2 wk postinjury: quadrupedal locomotion, forelimb exercise, or a nontrained group. Throughout the study (including preinjury), all animals were placed in metabolic cages once a week for 24 h to monitor water intake and urine output. Following the 10-wk period of daily 1-h treadmill training, awake cystometry data were collected and bladder and kidney tissue harvested for analysis. Metabolic cage frequency-volume measurements of voiding and cystometry reveal an impact of exercise training on multiple SCI-induced impairments related to various aspects of urinary tract function. Improvements in both the quadrupedal and forelimb-trained groups implicate underlying mechanisms beyond repetitive sensory information from the hindlimbs driving spinal network excitability of the lumbosacral urogenital neural circuitry. Furthermore, the impact of exercise training on the upper urinary tract (kidney) underscores the health benefit of activity-based training on the entire urinary system within the SCI population.

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Upregulation of the phosphorylated form of CREB in spinothalamic tract cells following spinal cord injury: Relation to central neuropathic pain

Neuroscience Letters ◽

10.1016/j.neulet.2005.04.066 ◽

2005 ◽

Vol 384 (1-2) ◽

pp. 139-144 ◽

Cited By ~ 28

Author(s):

E.D. Crown ◽

Z. Ye ◽

K.M. Johnson ◽

G.-Y. Xu ◽

D.J. McAdoo ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Neuropathic Pain ◽

Spinothalamic Tract ◽

Central Neuropathic Pain ◽

Phosphorylated Form ◽

Cord Injury

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Traumatic Cervical Cord Injury at C3–4 without Radiographic Abnormalities: Correlation of Magnetic Resonance Findings with Clinical Features and Outcome

Journal of Orthopaedic Surgery ◽

10.1177/230949900201000205 ◽

2002 ◽

Vol 10 (2) ◽

pp. 129-135 ◽

Cited By ~ 18

Author(s):

M Takahashi ◽

Y Harada ◽

H Inoue ◽

K Shimada

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Magnetic Resonance ◽

Clinical Features ◽

Cervical Spinal Cord ◽

Magnetic Resonance Images ◽

Clinical Severity ◽

Neurological Involvement ◽

Sensory Level ◽

Cord Injury

Purpose. Clinical features and outcomes of 43 patients at the Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama, were studied prospectively. These patients were not found to have radiographic abnormalities but magnetic resonance images showed acute cervical spinal cord trauma at the C3–4 disc level. Methods. Magnetic resonance images were analysed at presentation (immediately after the injury) and subsequent follow-up visits (at subacute and chronic stages, respectively) in an attempt to correlate imaging findings to clinical features and outcomes, respectively. Results. The injury mechanism was usually a yper-extension of the cervical spine. The level of neurological involvement was assessed in 9 patients with complete tetraplegia: the motor level was C5 in 6 patients and C4 in 3, whereas the sensory level was C5 in 7 patients, C4 in one, and C3 in one. Respiratory dysfunction in patients with severe paralysis, or numb and clumsy hands in patients with incomplete paralysis were the characteristic clinical features of cervical spinal cord injury at these lesions. Three patterns of signal change on magnetic resonance images were observed in patients with spinal cord injury at C3–4. A low-intensity area on T2-weighted images in the acute stage indicated a poor prognosis, while a high-intensity area at 2 to 3 weeks after injury indicated some degree of permanent paralysis. Conclusion. The serial signal changes of magnetic resonance images and the clinical severity or outcome seemed to be well correlated.

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Increased expression of metabotropic glutamate receptor subtype 1 on spinothalamic tract neurons following spinal cord injury in the rat

Neuroscience Letters ◽

10.1016/s0304-3940(01)02551-4 ◽

2002 ◽

Vol 319 (2) ◽

pp. 59-62 ◽

Cited By ~ 27

Author(s):

Charles D. Mills ◽

Claire E. Hulsebosch

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Glutamate Receptor ◽

Metabotropic Glutamate Receptor ◽

Receptor Subtype ◽

Spinothalamic Tract ◽

Metabotropic Glutamate ◽

Cord Injury

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Exoskeleton gait training to improve lower urinary tract function in people with motor-complete spinal cord injury: A randomized pilot trial

Journal of Rehabilitation Medicine ◽

10.2340/16501977-2864 ◽

2021 ◽

pp. 0

Author(s):

A Williams ◽

E Deegan ◽

M Walter ◽

L Stothers ◽

T Lam

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Lower Urinary Tract ◽

Pilot Trial ◽

Gait Training ◽

Cord Injury ◽

Lower Urinary Tract Function ◽

Tract Function ◽

Complete Spinal Cord Injury ◽

Lower Urinary

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Wallerian degeneration in cervical spinal cord tracts is commonly seen in routine T2-weighted MRI after traumatic spinal cord injury and is associated with impairment in a retrospective study

European Radiology ◽

10.1007/s00330-020-07388-2 ◽

2020 ◽

Author(s):

Tim Fischer ◽

Christoph Stern ◽

Patrick Freund ◽

Martin Schubert ◽

Reto Sutter

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Wallerian Degeneration ◽

Evoked Potential ◽

Corticospinal Tract ◽

Cervical Spinal Cord ◽

Dorsal Column ◽

Traumatic Spinal Cord Injury ◽

Spinothalamic Tract ◽

Cord Injury

Abstract Objectives Wallerian degeneration (WD) is a well-known process after nerve injury. In this study, occurrence of remote intramedullary signal changes, consistent with WD, and its correlation with clinical and neurophysiological impairment were assessed after traumatic spinal cord injury (tSCI). Methods In 35 patients with tSCI, WD was evaluated by two radiologists on T2-weighted images of serial routine MRI examinations of the cervical spine. Dorsal column (DC), lateral corticospinal tract (CS), and lateral spinothalamic tract (ST) were the analyzed anatomical regions. Impairment scoring according to the American Spinal Injury Association Impairment Scale (AIS, A–D) as well as a scoring system (0–4 points) for motor evoked potential (MEP) and sensory evoked potential (SEP) was included. Mann-Whitney U test was used to test for differences. Results WD in the DC occurred in 71.4% (n = 25), in the CS in 57.1% (n = 20), and in 37.1% (n = 13) in the ST. With WD present, AIS grades were worse for all tracts. DC: median AIS B vs D, p < 0.001; CS: B vs D, p = 0.016; and ST: B vs D, p = 0.015. More pathological MEP scores correlated with WD in the DC (median score 0 vs 3, p < 0.001) and in the CS (0 vs 2, p = 0.032). SEP scores were lower with WD in the DC only (1 vs 2, p = 0.031). Conclusions WD can be detected on T2-weighted scans in the majority of cervical spinal cord injury patients and should be considered as a direct effect of the trauma. When observed, it is associated with higher degree of impairment. Key Points • Wallerian degeneration is commonly seen in routine MRI after traumatic spinal cord injury. • Wallerian degeneration is visible in the anatomical regions of the dorsal column, the lateral corticospinal tract, and the lateral spinothalamic tract. • Presence of Wallerian degeneration is associated with higher degree of impairment.

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