Severity assessment of impairment in spinal cord injury; a systematic review on challenging points about International Standards for Neurological Classification of Spinal Cord Injury
-
Mahmoud Yousefifard
,
Mostafa Hosseini
,
Alireza Oraii
,
Alexander R. Vaccaro
,
Vafa Rahimi-Movaghar
Abstract
Objective: Assessment of spinal cord injuries (SCI) severity is usually done according to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). However, a limitation of ISNCSCI has not been thoroughly evaluate; therefore, a systematic review was performed to gather current evidence on the limitations of the ISNCSCI for assessing SCI. Methods: An extensive literature search was performed using Medline, Embase, Web of Science, Cochrane library, and Scopus for all articles up until the end of 2017 and then was updated to the end of 2020. Data was summarized by two independent reviewers and limitations of the ISNCSCI was further categorized. Results: 31 studies were included in the analysis. The limitations of ISNCSCI were classified into 6 domains: 1) lack of assessment of autonomic nervous system; 2) low value in assessing severity of SCI severity in children; 3) confounding factors which impact outcome are not accounted for by ISNCSCI; 4) lack of an established optimal cut off time point for administering the ISNCSCI; 5) low predictive and diagnostic value for assessing incomplete motor injuries; 6) poor classification and predictive value of the ISNCSCI. Conclusion: Although the ISNCSCI is a commonly used tool to assess the severity of SCI, there are several limitations.
1. Kirshblum SC, Waring W, Biering-Sorensen F, Burns SP, Johansen M, Schmidt-Read M, et al. Reference for the 2011 revision of the international standards for neurological classification of spinal cord injury. J Spinal Cord Med. 2011;34(6):547-54.
2. Schuld C, Franz S, Bruggemann K, Heutehaus L, Weidner N, Kirshblum SC, et al. International standards for neurological classification of spinal cord injury: impact of the revised worksheet (revision 02/13) on classification performance. J Spinal Cord Med. 2016;39(5):504-12.
3. Furlan JC, Noonan V, Singh A, Fehlings MG. Assessment of impairment in patients with acute traumatic spinal cord injury: a systematic review of the literature. J Neurotrauma. 2011;28(8):1445-77.
4. ASIA and ISCoS International Standards Committee. The 2019 revision of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)—What’s new? Spinal Cord. 2019;57(10):815-7.
5. Hayes KC, Wolfe DL, Hsieh JT, Potter PJ, Krassioukov A, Durham CE. Clinical and electrophysiologic correlates of quantitative sensory testing in patients with incomplete spinal cord injury. Arch Phys Med Rehabil. 2002;83(11):1612-9.
6. Fawcett JW, Curt A, Steeves JD, Coleman WP, Tuszynski MH, Lammertse D, et al. Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP panel: spontaneous recovery after spinal cord injury and statistical power needed for therapeutic clinical trials. Spinal Cord. 2007;45(3):190-205.
7. Mulcahey MJ, Gaughan J, Betz RR, Johansen KJ. The International Standards for Neurological Classification of Spinal Cord Injury: reliability of data when applied to children and youths. Spinal Cord. 2007;45(6):452-9.
8. Mulcahey MJ, Gaughan JP, Chafetz RS, Vogel LC, Samdani AF, Betz RR. Interrater reliability of the international standards for neurological classification of spinal cord injury in youths with chronic spinal cord injury. Arch Phys Med Rehabil. 2011;92(8):1264-9.
9. Vogel L, Samdani A, Chafetz R, Gaughan J, Betz R, Mulcahey MJ. Intra-rater agreement of the anorectal exam and classification of injury severity in children with spinal cord injury. Spinal Cord. 2009;47(9):687-91.
10. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology. JAMA. 2000;283(15):2008-12.
11. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264-9.
12. Coleman WP, Geisler FH. Injury severity as primary predictor of outcome in acute spinal cord injury: retrospective results from a large multicenter clinical trial. Spine J. 2004;4(4):373-8.
13. Davidson RA, Carlson M, Fallah N, Noonan VK, Elliott SL, Joseph J, et al. Inter-Rater Reliability of the International Standards to Document Remaining Autonomic Function after Spinal Cord Injury. J Neurotrauma. 2017;34(3):552-8.
14. Failli V, Kopp MA, Gericke C, Martus P, Klingbeil S, Brommer B, et al. Functional neurological recovery after spinal cord injury is impaired in patients with infections. Brain. 2012;135(Pt 11):3238-50.
15. Gundogdu I, Akyuz M, Ozturk EA, Cakci FA. Can spinal cord injury patients show a worsening in ASIA impairment scale classification despite actually having neurological improvement? The limitation of ASIA Impairment Scale Classification. Spinal Cord. 2014;52(9):667-70.
16. Kirshblum SC, Memmo P, Kim N, Campagnolo D, Millis S. Comparison of the revised 2000 American Spinal Injury Association classification standards with the 1996 guidelines. Am J Phys Med Rehabil. 2002;81(7):502-5.
17. Marino RJ, Rider-Foster D, Maissel G, Ditunno JF. Superiority of motes level over single neurological level in categorizing tetraplegia. Paraplegia. 1995;33(9):510-3.
18. Marino RJ, Graves DE. Metric properties of the ASIA motor score: subscales improve correlation with functional activities. Arch Phys Med Rehabil. 2004;85(11):1804-10.
19. Marino RJ, Jones L, Kirshblum S, Tal J, Dasgupta A. Reliability and repeatability of the motor and sensory examination of the international standards for neurological classification of spinal cord injury. J Spinal Cord Med. 2008;31(2):166-70.
20. Marino RJ, Burns S, Graves DE, Leiby BE, Kirshblum S, Lammertse DP. Upper- and lower-extremity motor recovery after traumatic cervical spinal cord injury: an update from the national spinal cord injury database. Arch Phys Med Rehabil. 2011;92(3):369-75.
21. McCoy E, Eftekhary N, Nwosu K, Fukunaga D, Liu C, Rolfe K. American Spinal Injury Association A (sensory and motor complete) is not different from American Spinal Injury Association B (sensory incomplete, motor complete) in gunshot-related spinal cord injury. Spine J. 2017;17(12):1846-9.
22. Menaker J, Kufera JA, Glaser J, Stein DM, Scalea TM. Admission ASIA motor score predicting the need for tracheostomy after cervical spinal cord injury. J Trauma Acute Care Surg. 2013;75(4):629-34.
23. Previnaire JG, Soler JM, El Masri W, Denys P. Assessment of the sympathetic level of lesion in patients with spinal cord injury. Spinal Cord. 2009;47(2):122-7.
24. Previnaire JG, Mathias CJ, El Masri W, Soler JM, Leclercq V, Denys P. The isolated sympathetic spinal cord: Cardiovascular and sudomotor assessment in spinal cord injury patients: A literature survey. Ann Phys Rehabil Med. 2010;53(8):520-32.
25. Schuld C, Franz S, van Hedel HJ, Moosburger J, Maier D, Abel R, et al. International standards for neurological classification of spinal cord injury: classification skills of clinicians versus computational algorithms. Spinal Cord. 2015;53(4):324-31.
26. Shin JC, Yoo JH, Jung TH, Goo HR. Comparison of lower extremity motor score parameters for patients with motor incomplete spinal cord injury using gait parameters. Spinal Cord. 2011;49(4):529-33.
27. Spiess MR, Muller RM, Rupp R, Schuld C, van Hedel HJ. Conversion in ASIA impairment scale during the first year after traumatic spinal cord injury. J Neurotrauma. 2009;26(11):2027-36.
28. van Middendorp JJ, Hosman AJ, Pouw MH, Van de Meent H. ASIA impairment scale conversion in traumatic SCI: is it related with the ability to walk? A descriptive comparison with functional ambulation outcome measures in 273 patients. Spinal Cord. 2009;47(7):555-60.
29. van Middendorp JJ, Hosman AJ, Pouw MH, Van de Meent H. Is determination between complete and incomplete traumatic spinal cord injury clinically relevant? Validation of the ASIA sacral sparing criteria in a prospective cohort of 432 patients. Spinal Cord. 2009;47(11):809-16.
30. West CR, Wong SC, Krassioukov AV. Autonomic cardiovascular control in Paralympic athletes with spinal cord injury. Med Sci Sports Exerc. 2014;46(1):60-8.
31. Zariffa J, Curt A, Steeves JD. Functional motor preservation below the level of injury in subjects with American Spinal Injury Association Impairment Scale grade A spinal cord injuries. Arch Phys Med Rehabil. 2012;93(5):905-7.
32. van Middendorp JJ, Hosman AJ, Donders AR, Pouw MH, Ditunno JF, Jr., Curt A, et al. A clinical prediction rule for ambulation outcomes after traumatic spinal cord injury: a longitudinal cohort study. Lancet (London, England). 2011;377(9770):1004-10.
33. Chafetz RS, Gaughan JP, Vogel LC, Betz R, Mulcahey MJ. The international standards for neurological classification of spinal cord injury: intra-rater agreement of total motor and sensory scores in the pediatric population. J Spin Cord Med. 2009;32(2):157-61.
34. Osunronbi T, Sharma H. International Standards for Neurological Classification of Spinal Cord Injury: factors influencing the frequency, completion and accuracy of documentation of neurology for patients with traumatic spinal cord injuries. Eur J Orthop Surg Traumatol. 2019;29(8):1639-48.
35. Kirshblum S, Didesch M, Botticello A, Kong B, Androwis D. Patient preferences for order of the sensory portion of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) examination. J Spinal Cord Med. 2019;42(6):719-24.
36. Armstrong AJ, Clark JM, Ho DT, Payne CJ, Nolan S, Goodes LM, et al. Achieving assessor accuracy on the International Standards for Neurological Classification of Spinal Cord Injury. Spinal Cord. 2017;55(11):994-1001.
37. Alexander M, Carr C, Alexander J, Chen Y, McLain A. Assessing the ability of the Sacral Autonomic Standards to document bladder and bowel function based upon the Asia Impairment Scale. Spinal Cord Ser Cases. 2019;5(1):85.
38. Hou S, Rabchevsky AG. Autonomic consequences of spinal cord injury. Compr Physiol. 2014;4(4):1419-53.
39. Hou S, Lu P, Blesch A. Characterization of supraspinal vasomotor pathways and autonomic dysreflexia after spinal cord injury in F344 rats. Auton Neurosci. 2013;176(1-2):54-63.
40. Krassioukov A. Which pathways must be spared in the injured human spinal cord to retain cardiovascular control? Prog Brain Res. 2006;152:39-47.
41. Alexander MS, Biering-Sorensen F, Bodner D, Brackett NL, Cardenas D, Charlifue S, et al. International standards to document remaining autonomic function after spinal cord injury. Spinal Cord. 2009;47(1):36-43.
42. Parent S, Mac-Thiong J-M, Roy-Beaudry M, Sosa JF, Labelle H. Spinal Cord Injury in the Pediatric Population: A Systematic Review of the Literature. J Neurotrauma. 2011;28(8):1515-24.
43. Scivoletto G, Di Donna V. Prediction of walking recovery after spinal cord injury. Brain Res Bull. 2009;78(1):43-51.
44. Kaminski L, Cordemans V, Cernat E, M'Bra KI, Mac-Thiong JM. Functional Outcome Prediction after Traumatic Spinal Cord Injury Based on Acute Clinical Factors. J Neurotrauma. 2017;34(12):2027-33.
45. Childs BR, Moore TA, Como JJ, Vallier HA. American Spinal Injury Association Impairment Scale Predicts the Need for Tracheostomy After Cervical Spinal Cord Injury. Spine. 2015;40(18):1407-13.
46. Wilson JR, Grossman RG, Frankowski RF, Kiss A, Davis AM, Kulkarni AV, et al. A Clinical Prediction Model for Long-Term Functional Outcome after Traumatic Spinal Cord Injury Based on Acute Clinical and Imaging Factors. J Neurotrauma. 2012;29(13):2263-71.
47. Maynard Jr FM, Bracken MB, Creasey G, Ditunno Jr JF, Donovan WH, Ducker TB, et al. International standards for neurological and functional classification of spinal cord injury. Spinal Cord. 1997;35(5):266.
48. Schuld C, Wiese J, Franz S, Putz C, Stierle I, Smoor I, et al. Effect of formal training in scaling, scoring and classification of the International Standards for Neurological Classification of Spinal Cord Injury. Spinal Cord. 2013;51(4):282-8.
49. Chafetz RS, Vogel LC, Betz RR, Gaughan JP, Mulcahey MJ. International standards for neurological classification of spinal cord injury: training effect on accurate classification. J Spinal Cord Med. 2008;31(5):538-42.
50. Liu N, Zhou MW, Krassioukov AV, Biering-Sorensen F. Training effectiveness when teaching the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) to medical students. Spinal Cord. 2013;51(10):768-71.
51. Burns AS, Lee BS, Ditunno JF, Jr., Tessler A. Patient selection for clinical trials: the reliability of the early spinal cord injury examination. J Neurotrauma. 2003;20(5):477-82.
52. Maynard FM, Reynolds GG, Fountain S, Wilmot C, Hamilton R. Neurological prognosis after traumatic quadriplegia: three-year experience of California Regional Spinal Cord Injury Care System. J Neurosurg. 1979;50(5):611-6.
53. Ditunno JF, Cohen ME, Hauck WW, Jackson AB, Sipski ML. Recovery of upper-extremity strength in complete and incomplete tetraplegia: a multicenter study. Arch Phys Med Rehabil. 2000;81(4):389-93.
54. Waters RL, Adkins RH, Yakura JS, Sie I. Motor and sensory recovery following complete tetraplegia. Arch Phys Med Rehabil. 1993;74(3):242-7.
55. Waters RL, Adkins RH, Yakura JS, Sie I. Motor and sensory recovery following incomplete paraplegia. Arch Phys Med Rehabil. 1994;75(1):67-72.
2. Schuld C, Franz S, Bruggemann K, Heutehaus L, Weidner N, Kirshblum SC, et al. International standards for neurological classification of spinal cord injury: impact of the revised worksheet (revision 02/13) on classification performance. J Spinal Cord Med. 2016;39(5):504-12.
3. Furlan JC, Noonan V, Singh A, Fehlings MG. Assessment of impairment in patients with acute traumatic spinal cord injury: a systematic review of the literature. J Neurotrauma. 2011;28(8):1445-77.
4. ASIA and ISCoS International Standards Committee. The 2019 revision of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)—What’s new? Spinal Cord. 2019;57(10):815-7.
5. Hayes KC, Wolfe DL, Hsieh JT, Potter PJ, Krassioukov A, Durham CE. Clinical and electrophysiologic correlates of quantitative sensory testing in patients with incomplete spinal cord injury. Arch Phys Med Rehabil. 2002;83(11):1612-9.
6. Fawcett JW, Curt A, Steeves JD, Coleman WP, Tuszynski MH, Lammertse D, et al. Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP panel: spontaneous recovery after spinal cord injury and statistical power needed for therapeutic clinical trials. Spinal Cord. 2007;45(3):190-205.
7. Mulcahey MJ, Gaughan J, Betz RR, Johansen KJ. The International Standards for Neurological Classification of Spinal Cord Injury: reliability of data when applied to children and youths. Spinal Cord. 2007;45(6):452-9.
8. Mulcahey MJ, Gaughan JP, Chafetz RS, Vogel LC, Samdani AF, Betz RR. Interrater reliability of the international standards for neurological classification of spinal cord injury in youths with chronic spinal cord injury. Arch Phys Med Rehabil. 2011;92(8):1264-9.
9. Vogel L, Samdani A, Chafetz R, Gaughan J, Betz R, Mulcahey MJ. Intra-rater agreement of the anorectal exam and classification of injury severity in children with spinal cord injury. Spinal Cord. 2009;47(9):687-91.
10. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology. JAMA. 2000;283(15):2008-12.
11. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264-9.
12. Coleman WP, Geisler FH. Injury severity as primary predictor of outcome in acute spinal cord injury: retrospective results from a large multicenter clinical trial. Spine J. 2004;4(4):373-8.
13. Davidson RA, Carlson M, Fallah N, Noonan VK, Elliott SL, Joseph J, et al. Inter-Rater Reliability of the International Standards to Document Remaining Autonomic Function after Spinal Cord Injury. J Neurotrauma. 2017;34(3):552-8.
14. Failli V, Kopp MA, Gericke C, Martus P, Klingbeil S, Brommer B, et al. Functional neurological recovery after spinal cord injury is impaired in patients with infections. Brain. 2012;135(Pt 11):3238-50.
15. Gundogdu I, Akyuz M, Ozturk EA, Cakci FA. Can spinal cord injury patients show a worsening in ASIA impairment scale classification despite actually having neurological improvement? The limitation of ASIA Impairment Scale Classification. Spinal Cord. 2014;52(9):667-70.
16. Kirshblum SC, Memmo P, Kim N, Campagnolo D, Millis S. Comparison of the revised 2000 American Spinal Injury Association classification standards with the 1996 guidelines. Am J Phys Med Rehabil. 2002;81(7):502-5.
17. Marino RJ, Rider-Foster D, Maissel G, Ditunno JF. Superiority of motes level over single neurological level in categorizing tetraplegia. Paraplegia. 1995;33(9):510-3.
18. Marino RJ, Graves DE. Metric properties of the ASIA motor score: subscales improve correlation with functional activities. Arch Phys Med Rehabil. 2004;85(11):1804-10.
19. Marino RJ, Jones L, Kirshblum S, Tal J, Dasgupta A. Reliability and repeatability of the motor and sensory examination of the international standards for neurological classification of spinal cord injury. J Spinal Cord Med. 2008;31(2):166-70.
20. Marino RJ, Burns S, Graves DE, Leiby BE, Kirshblum S, Lammertse DP. Upper- and lower-extremity motor recovery after traumatic cervical spinal cord injury: an update from the national spinal cord injury database. Arch Phys Med Rehabil. 2011;92(3):369-75.
21. McCoy E, Eftekhary N, Nwosu K, Fukunaga D, Liu C, Rolfe K. American Spinal Injury Association A (sensory and motor complete) is not different from American Spinal Injury Association B (sensory incomplete, motor complete) in gunshot-related spinal cord injury. Spine J. 2017;17(12):1846-9.
22. Menaker J, Kufera JA, Glaser J, Stein DM, Scalea TM. Admission ASIA motor score predicting the need for tracheostomy after cervical spinal cord injury. J Trauma Acute Care Surg. 2013;75(4):629-34.
23. Previnaire JG, Soler JM, El Masri W, Denys P. Assessment of the sympathetic level of lesion in patients with spinal cord injury. Spinal Cord. 2009;47(2):122-7.
24. Previnaire JG, Mathias CJ, El Masri W, Soler JM, Leclercq V, Denys P. The isolated sympathetic spinal cord: Cardiovascular and sudomotor assessment in spinal cord injury patients: A literature survey. Ann Phys Rehabil Med. 2010;53(8):520-32.
25. Schuld C, Franz S, van Hedel HJ, Moosburger J, Maier D, Abel R, et al. International standards for neurological classification of spinal cord injury: classification skills of clinicians versus computational algorithms. Spinal Cord. 2015;53(4):324-31.
26. Shin JC, Yoo JH, Jung TH, Goo HR. Comparison of lower extremity motor score parameters for patients with motor incomplete spinal cord injury using gait parameters. Spinal Cord. 2011;49(4):529-33.
27. Spiess MR, Muller RM, Rupp R, Schuld C, van Hedel HJ. Conversion in ASIA impairment scale during the first year after traumatic spinal cord injury. J Neurotrauma. 2009;26(11):2027-36.
28. van Middendorp JJ, Hosman AJ, Pouw MH, Van de Meent H. ASIA impairment scale conversion in traumatic SCI: is it related with the ability to walk? A descriptive comparison with functional ambulation outcome measures in 273 patients. Spinal Cord. 2009;47(7):555-60.
29. van Middendorp JJ, Hosman AJ, Pouw MH, Van de Meent H. Is determination between complete and incomplete traumatic spinal cord injury clinically relevant? Validation of the ASIA sacral sparing criteria in a prospective cohort of 432 patients. Spinal Cord. 2009;47(11):809-16.
30. West CR, Wong SC, Krassioukov AV. Autonomic cardiovascular control in Paralympic athletes with spinal cord injury. Med Sci Sports Exerc. 2014;46(1):60-8.
31. Zariffa J, Curt A, Steeves JD. Functional motor preservation below the level of injury in subjects with American Spinal Injury Association Impairment Scale grade A spinal cord injuries. Arch Phys Med Rehabil. 2012;93(5):905-7.
32. van Middendorp JJ, Hosman AJ, Donders AR, Pouw MH, Ditunno JF, Jr., Curt A, et al. A clinical prediction rule for ambulation outcomes after traumatic spinal cord injury: a longitudinal cohort study. Lancet (London, England). 2011;377(9770):1004-10.
33. Chafetz RS, Gaughan JP, Vogel LC, Betz R, Mulcahey MJ. The international standards for neurological classification of spinal cord injury: intra-rater agreement of total motor and sensory scores in the pediatric population. J Spin Cord Med. 2009;32(2):157-61.
34. Osunronbi T, Sharma H. International Standards for Neurological Classification of Spinal Cord Injury: factors influencing the frequency, completion and accuracy of documentation of neurology for patients with traumatic spinal cord injuries. Eur J Orthop Surg Traumatol. 2019;29(8):1639-48.
35. Kirshblum S, Didesch M, Botticello A, Kong B, Androwis D. Patient preferences for order of the sensory portion of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) examination. J Spinal Cord Med. 2019;42(6):719-24.
36. Armstrong AJ, Clark JM, Ho DT, Payne CJ, Nolan S, Goodes LM, et al. Achieving assessor accuracy on the International Standards for Neurological Classification of Spinal Cord Injury. Spinal Cord. 2017;55(11):994-1001.
37. Alexander M, Carr C, Alexander J, Chen Y, McLain A. Assessing the ability of the Sacral Autonomic Standards to document bladder and bowel function based upon the Asia Impairment Scale. Spinal Cord Ser Cases. 2019;5(1):85.
38. Hou S, Rabchevsky AG. Autonomic consequences of spinal cord injury. Compr Physiol. 2014;4(4):1419-53.
39. Hou S, Lu P, Blesch A. Characterization of supraspinal vasomotor pathways and autonomic dysreflexia after spinal cord injury in F344 rats. Auton Neurosci. 2013;176(1-2):54-63.
40. Krassioukov A. Which pathways must be spared in the injured human spinal cord to retain cardiovascular control? Prog Brain Res. 2006;152:39-47.
41. Alexander MS, Biering-Sorensen F, Bodner D, Brackett NL, Cardenas D, Charlifue S, et al. International standards to document remaining autonomic function after spinal cord injury. Spinal Cord. 2009;47(1):36-43.
42. Parent S, Mac-Thiong J-M, Roy-Beaudry M, Sosa JF, Labelle H. Spinal Cord Injury in the Pediatric Population: A Systematic Review of the Literature. J Neurotrauma. 2011;28(8):1515-24.
43. Scivoletto G, Di Donna V. Prediction of walking recovery after spinal cord injury. Brain Res Bull. 2009;78(1):43-51.
44. Kaminski L, Cordemans V, Cernat E, M'Bra KI, Mac-Thiong JM. Functional Outcome Prediction after Traumatic Spinal Cord Injury Based on Acute Clinical Factors. J Neurotrauma. 2017;34(12):2027-33.
45. Childs BR, Moore TA, Como JJ, Vallier HA. American Spinal Injury Association Impairment Scale Predicts the Need for Tracheostomy After Cervical Spinal Cord Injury. Spine. 2015;40(18):1407-13.
46. Wilson JR, Grossman RG, Frankowski RF, Kiss A, Davis AM, Kulkarni AV, et al. A Clinical Prediction Model for Long-Term Functional Outcome after Traumatic Spinal Cord Injury Based on Acute Clinical and Imaging Factors. J Neurotrauma. 2012;29(13):2263-71.
47. Maynard Jr FM, Bracken MB, Creasey G, Ditunno Jr JF, Donovan WH, Ducker TB, et al. International standards for neurological and functional classification of spinal cord injury. Spinal Cord. 1997;35(5):266.
48. Schuld C, Wiese J, Franz S, Putz C, Stierle I, Smoor I, et al. Effect of formal training in scaling, scoring and classification of the International Standards for Neurological Classification of Spinal Cord Injury. Spinal Cord. 2013;51(4):282-8.
49. Chafetz RS, Vogel LC, Betz RR, Gaughan JP, Mulcahey MJ. International standards for neurological classification of spinal cord injury: training effect on accurate classification. J Spinal Cord Med. 2008;31(5):538-42.
50. Liu N, Zhou MW, Krassioukov AV, Biering-Sorensen F. Training effectiveness when teaching the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) to medical students. Spinal Cord. 2013;51(10):768-71.
51. Burns AS, Lee BS, Ditunno JF, Jr., Tessler A. Patient selection for clinical trials: the reliability of the early spinal cord injury examination. J Neurotrauma. 2003;20(5):477-82.
52. Maynard FM, Reynolds GG, Fountain S, Wilmot C, Hamilton R. Neurological prognosis after traumatic quadriplegia: three-year experience of California Regional Spinal Cord Injury Care System. J Neurosurg. 1979;50(5):611-6.
53. Ditunno JF, Cohen ME, Hauck WW, Jackson AB, Sipski ML. Recovery of upper-extremity strength in complete and incomplete tetraplegia: a multicenter study. Arch Phys Med Rehabil. 2000;81(4):389-93.
54. Waters RL, Adkins RH, Yakura JS, Sie I. Motor and sensory recovery following complete tetraplegia. Arch Phys Med Rehabil. 1993;74(3):242-7.
55. Waters RL, Adkins RH, Yakura JS, Sie I. Motor and sensory recovery following incomplete paraplegia. Arch Phys Med Rehabil. 1994;75(1):67-72.
| Files | ||
| Issue | Vol 6 No 2 (2022): Spring (April) | |
| Section | Systematic review / Meta-analysis | |
| DOI | 10.18502/fem.v6i2.8717 | |
| Keywords | ||
| Limitation Outcome Measures Spinal Cord Injury Systematic Review | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Yousefifard M, Hosseini M, Oraii A, Vaccaro A, Rahimi-Movaghar V. Severity assessment of impairment in spinal cord injury; a systematic review on challenging points about International Standards for Neurological Classification of Spinal Cord Injury. Front Emerg Med. 2022;6(2):e22.
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