Τρίτη, 21 Ιουνίου 2016

Response to letter to the editor regarding: “Local versus distal transplantation of human neural stem cells following chronic spinal cord injury” by Cheng et al

We thank the letter writers for their insightful comments on our article [1] and for highlighting the difficulty in creating a consistent spinal cord injury (SCI) in the rodent model. Over multiple studies [1–3], we have refined the surgical technique to be consistent and reproducible, with the senior author performing all the surgeries and utilizing computer assistance to ensure uniform impact to the spinal cords. All rats demonstrated consistent SCI after surgery upon examination using the Basso, Beattie, Bresnahan locomotor score.

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Editorial Board



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Letter to the editor regarding “Local versus distal transplantation of human neural stem cells following chronic spinal cord injury” by Cheng et al.

We read the recently published article "Local versus distal transplantation of human neural stem cells following chronic spinal cord injury" by Cheng et al. [1], with great interest. The article demonstrated "The transplantation of human neural stem cells (hNSCs) into the rat's chronically injured spinal cord led to significant functional recovery when injected distally but not locally to the site of chronic spinal cord injury (SCI)." Cheng et al. [1] evaluated functional recovery, post transplantation, using the 21-point Basso, Beattie, and Bresnahan locomotor score.

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Sagittal alignment changes and proximal junctional kyphosis in adolescent idiopathic scoliosis

Commentary On Basques BA, Long WD, 3rd, Golinvaux NS, Bohl DD, Samuel AM, Lukasiewicz AM, et al. Poor visualization limits diagnosis of proximal junctional kyphosis in adolescent idiopathic scoliosis. Spine J 2015. doi:10.1016/j.spinee.2015.10.040

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A postoperative risk scoring system?

Munch JL, Zusman NL, Lieberman EG, Stucke RS, Bell C, Philipp TC, et al. A scoring system to predict postoperative medical complications in high-risk patients undergoing elective thoracic and lumbar arthrodesis. Spine J 2016:16:694–9 (in this issue).

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Response to the letter to the editor regarding: “Circulatory dynamics of the cauda equina in lumbar canal stenosis using dynamic contrast-enhanced magnetic resonance imaging.” Spine J. 2015;15(10):2132–2141

We thank Dr Jeffrey S. Ross for their interest in our article and would like to respond to their criticisms of our work. We agree about our poor magnetic resonance imaging (MRI) technique and the need to improve it in the future. However, I think the visualization of intraradicular edema by MRI provides very useful help in the diagnosis of lumbar canal stenosis level before surgery. It is generally considered that the genesis of radiculopathy rests not only with mechanical compression but also with circulatory disturbance of the nerve root.

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Regarding “Circulatory dynamics of the cauda equina in lumbar canal stenosis using dynamic contrast-enhanced magnetic resonance imaging”

I read with interest the article by Kobayashi et al. in The Spine Journal October issue [1]. The occurrence of enhancement at the site of lumbar canal stenosis is an important one, and infrequently encountered in routine imaging of the lumbar spine, because contrast material is generally not given. When it does occur, it can be a source of confusion to the clinician and radiologist, who might ascribe a more ominous diagnosis of enhancing tumor or infection. The authors are to be commended for studying this topic.

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Table of Contents



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Table of Contents



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Interspinous spacers for lumbar spinal stenosis: commentary on van den Akker-van Marle et al.

COMMENTARY ON: van den Akker-van Marle ME, Moojen WA, Arts MP, Vleggeert-Lankamp CLAM, Peul WC, for the Leiden-The Hague Spine Intervention Prognostic Study Group (SIPS). Interspinous process devices versus standard conventional surgical decompression for lumbar spinal stenosis: cost-utility analysis. Spine J 2016:16:702–10 (in this issue).

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The involvement of model-based but not model-free learning signals during observational reward learning in the absence of choice

A major open question is whether computational strategies thought to be used during experiential learning, specifically model-based and model-free reinforcement learning, also support observational learning. Furthermore, the question of how observational learning occurs when observers must learn about the value of options from observing outcomes in the absence of choice has not been addressed. In the present study we used a multi-armed bandit task that encouraged human participants to employ both experiential and observational learning while they underwent functional magnetic resonance imaging (fMRI). We found evidence for the presence of model-based learning signals during both observational and experiential learning in the intraparietal sulcus. However, unlike during experiential learning, model-free learning signals in the ventral striatum were not detectable during this form of observational learning. These results provide insight into the flexibility of the model-based learning system, implicating this system in learning during observation as well as from direct experience, and further suggest that the model-free reinforcement learning system may be less flexible with regard to its involvement in observational learning.



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Nitric oxide/cGMP/PKG signaling pathway activated by M1-type muscarinic acetylcholine receptor cascade inhibits Na+-activated K+ currents in Kenyon cells

The interneurons of the mushroom body, known as Kenyon cells, are essential for the long-term memory of olfactory associative learning in some insects. Some studies have reported that nitric oxide (NO) is strongly related to this long-term memory in Kenyon cells. However, the target molecules and upstream and downstream NO signaling cascades are not completely understood. Here we analyzed the effect of the NO signaling cascade on Na+-activated K+ (KNa) channel activity in Kenyon cells of crickets (Gryllus bimaculatus). We found that two different NO donors, S-nitrosoglutathione (GSNO) and S-nitroso-N-acetyl-dl-penicillamine (SNAP), strongly suppressed KNa channel currents. Additionally, this inhibitory effect of GSNO on KNa channel activity was diminished by 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ), an inhibitor of soluble guanylate cyclase (sGC), and KT5823, an inhibitor of protein kinase G (PKG). Next, we analyzed the role of ACh in the NO signaling cascade. ACh strongly suppressed KNa channel currents, similar to NO donors. Furthermore, this inhibitory effect of ACh was blocked by pirenzepine, an M1 muscarinic ACh receptor antagonist, but not by 1,1-dimethyl-4-diphenylacetoxypiperidinium iodide (4-DAMP) and mecamylamine, an M3 muscarinic ACh receptor antagonist and a nicotinic ACh receptor antagonist, respectively. The ACh-induced inhibition of KNa channel currents was also diminished by the PLC inhibitor U73122 and the calmodulin antagonist W-7. Finally, we found that ACh inhibition was blocked by the nitric oxide synthase (NOS) inhibitor NG-nitro-l-arginine methyl ester (l-NAME). These results suggested that the ACh signaling cascade promotes NO production by activating NOS and NO inhibits KNa channel currents via the sGC/cGMP/PKG signaling cascade in Kenyon cells.



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High-resolution and cell-type-specific photostimulation mapping shows weak excitatory vs. strong inhibitory inputs in the bed nucleus of the stria terminalis

The bed nucleus of the stria terminalis (BNST) is a key component of the extended amygdala and has been implicated in anxiety and addiction. As individual neurons function within neural circuits, it is important to understand local microcircuits and larger network connections of identified neuronal types and understand how maladaptive changes in the BNST neural networks are induced by stress and drug abuse. However, due to limitations of classic anatomical and physiological methods, the local circuit organization of synaptic inputs to specific BNST neuron types is not well understood. In this study, we report on the application of high-resolution and cell-type-specific photostimulation methodology developed in our laboratory to local circuit mapping in the BNST. Under calibrated experimental conditions, laser photostimulation via glutamate uncaging or channelrhodopsin-2 photoactivation evokes spiking of BNST neurons perisomatically, without activating spikes from axons of passage or distal dendrites. Whole cell recordings, combined with spatially restricted photostimulation of presynaptic neurons at many different locations over a large region, allow high-resolution mapping of presynaptic input sources to single recorded neurons in the BNST. We constructed maps of synaptic inputs impinging onto corticotrophin-releasing hormone-expressing (CRH+) BNST neurons in the dorsolateral BNST and found that the CRH+ neurons receive predominant local inhibitory synaptic connections with very weak excitatory connections. Through cell-type-specific optogenetic stimulation mapping, we generated maps of somatostatin-expressing neuron-specific inhibitory inputs to BNST neurons. Taken together, the photostimulation-based techniques offer us powerful tools for determining the functional organization of local circuits of specific BNST neuron types.



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Implicit learning and generalization of stretch response modulation in humans

Adaptation of neural responses to repeated muscle stretching likely represents implicit learning to minimize muscle resistance to perturbations. To test this hypothesis, the forearm was placed on a horizontal manipulandum. Elbow flexors or extensors compensated an external load and were stretched by 20° or 70° rotations. Participants were instructed not to intervene by intentionally modifying the muscle resistance elicited by stretching. In addition to phasic stretch reflexes (SRs), muscle stretching was associated with inhibitory periods (IPs) in the ongoing muscle activity starting at minimal latencies of ~35 ms. The SR amplitude decreased dramatically across 5–12 trials and was not restored after a resting period of 3–5 min, despite the increase in stretch amplitude from 20° to 70°, but IPs remained present. When SRs were suppressed, stretching of originally nonstretched, antagonist muscles initiated after the rest period showed immediate SR suppression while IPs remained present in the first and subsequent trials. Adaptation to muscle stretching thus includes features characteristic of implicit learning such as memory consolidation and generalization. Adaptation may be achieved by central shifts in the threshold positions at which muscles begin to be activated. Shifts are thought to be prepared in advance and triggered with stretch onset. Threshold position resetting provides a comprehensive explanation of the results in the broader context of the control of posture, movement, and motor learning in the healthy and damaged nervous system.



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Similar prevalence and magnitude of auditory-evoked and visually evoked activity in the frontal eye fields: implications for multisensory motor control

Saccadic eye movements can be elicited by more than one type of sensory stimulus. This implies substantial transformations of signals originating in different sense organs as they reach a common motor output pathway. In this study, we compared the prevalence and magnitude of auditory- and visually evoked activity in a structure implicated in oculomotor processing, the primate frontal eye fields (FEF). We recorded from 324 single neurons while 2 monkeys performed delayed saccades to visual or auditory targets. We found that 64% of FEF neurons were active on presentation of auditory targets and 87% were active during auditory-guided saccades, compared with 75 and 84% for visual targets and saccades. As saccade onset approached, the average level of population activity in the FEF became indistinguishable on visual and auditory trials. FEF activity was better correlated with the movement vector than with the target location for both modalities. In summary, the large proportion of auditory-responsive neurons in the FEF, the similarity between visual and auditory activity levels at the time of the saccade, and the strong correlation between the activity and the saccade vector suggest that auditory signals undergo tailoring to match roughly the strength of visual signals present in the FEF, facilitating accessing of a common motor output pathway.



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911 outages a danger to all

When I was working as an EMS communication center supervisor, a veteran dispatcher perfectly described the center's function as the "head of the beast."

While most EMS providers perform critical field functions, personnel within a modern day 911 call center are responsible for coordinating all of an EMS system's resources. From call intake, pre-arrival instructions and dispatch, to resource monitoring, inter- and intra-agency coordination and scheduling routine calls, a 911 telecommunications center has to be functional 100 percent of the time.

Beyond the training and expertise of its human resources, the technical aspects of the system must also be of high quality, and the ability to rapidly bring backup systems online must be reliable.

As the recent breakdown of the Baltimore 911 system demonstrated, the potential of a major crisis caused by a system failure can't be understated. Judging from the media reports, it looks like the incident was handled quickly, with some concern about communicating the backup plan to the general public.

What's more interesting — and concerning — to me is the second part of the article. It's true that most current 911 systems are rooted in older "Plain Old Telephone Service" (POTS) technology.

Hundreds and thousands of miles of copper wires connect a community's landline phones to a separate system that allows automatic number identification and automatic location identification to happen when a 911 call is placed. A traditional 911 system can allow a telecommunicator to lock the connection with the caller or even to re-establish contact when the line is open.

The entire system is also antiquated. In today's world of modern telephony and the convergence of digital data with voice, the existing 911 system is unable to deliver the data throughput necessary to transmit or sustain things like video calls or text messages. Such abilities can be delivered through internet-based communication systems, similar to many of the business-oriented communication systems now exist.

POTS does have one major difference. It is a closed system.

Internet systems are by nature, open.

Sophisticated and expensive processes exist to prevent unauthorized entry by those with more nefarious intent to disrupt public safety communications. To do so would be to interrupt the minute-to-minute operations. At best, that could mean dropped calls for service; at worse, a system may be unable to respond adequately to a major act of terrorism.

Florida officials described a 911 outage as a "very scary few hours." A report of the January incident, released last week, blamed the 911 outage as a mixture of human and technological error during a software upgrade, which rendered the system unstable.

Most EMS professionals never think about the reliability of their communication systems. It's a mere inconvenience when a unit is unable to establish or maintain a connection or when dispatch sends the wrong unit or over triage a call.

But the nightmare scenario of an accidental or intentional major communication blackout, stranding responders in the field, and being unable to convey information among officials, other agencies and public weighs heavily in the minds of 911 system designers.

While the new technology may be more powerful, it does come with its weaknesses that can be exploited.



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911 outages a danger to all

Modern and legacy 911 telecommunication systems have weaknesses and potential failure points, which puts civilians and responders at risk

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Are you smarter than an EMT student? Test your knowledge!

The introductory module of any course has important information, but EMT students frequently gloss over that content for the "cool" material in the airway or trauma chapters. This quiz will reveal if you paid attention in your classes on A&P, lifespan development, medical/legal and more. Are you smarter than an EMT student"



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Creatine Supplementation and Upper Limb Strength Performance: A Systematic Review and Meta-Analysis

Abstract

Background

Creatine is the most widely used supplementation to increase performance in strength; however, the most recent meta-analysis focused specifically on supplementation responses in muscles of the lower limbs without regard to upper limbs.

Objective

We aimed to systematically review the effect of creatine supplementation on upper limb strength performance.

Methods

We conducted a systematic review and meta-analyses of all randomized controlled trials comparing creatine supplementation with a placebo, with strength performance measured in exercises shorter than 3 min in duration. The search strategy used the keywords 'creatine', 'supplementation', and 'performance'. Independent variables were age, sex and level of physical activity at baseline, while dependent variables were creatine loading, total dose, duration, time interval between baseline (T0) and the end of the supplementation (T1), and any training during supplementation. We conducted three meta-analyses: at T0 and T1, and on changes between T0 and T1. Each meta-analysis was stratified within upper limb muscle groups.

Results

We included 53 studies (563 individuals in the creatine supplementation group and 575 controls). Results did not differ at T0, while, at T1, the effect size (ES) for bench press and chest press were 0.265 (95 % CI 0.132–0.398; p < 0.001) and 0.677 (95 % CI 0.149–1.206; p = 0.012), respectively. Overall, pectoral ES was 0.289 (95 % CI 0.160–0.419; p = 0.000), and global upper limb ES was 0.317 (95 % CI 0.185–0.449; p < 0.001). Meta-analysis of changes between T0 and T1 gave similar results. The meta-regression showed no link with characteristics of population or supplementation, demonstrating the efficacy of creatine independently of all listed conditions.

Conclusion

Creatine supplementation is effective in upper limb strength performance for exercise with a duration of less than 3  min, independent of population characteristics, training protocols, and supplementary doses or duration.



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The Epidemiology of Injuries Across the Weight-Training Sports

Abstract

Background

Weight-training sports, including weightlifting, powerlifting, bodybuilding, strongman, Highland Games, and CrossFit, are weight-training sports that have separate divisions for males and females of a variety of ages, competitive standards, and bodyweight classes. These sports may be considered dangerous because of the heavy loads commonly used in training and competition.

Objectives

Our objective was to systematically review the injury epidemiology of these weight-training sports, and, where possible, gain some insight into whether this may be affected by age, sex, competitive standard, and bodyweight class.

Methods

We performed an electronic search using PubMed, SPORTDiscus, CINAHL, and Embase for injury epidemiology studies involving competitive athletes in these weight-training sports. Eligible studies included peer-reviewed journal articles only, with no limit placed on date or language of publication. We assessed the risk of bias in all studies using an adaption of the musculoskeletal injury review method.

Results

Only five of the 20 eligible studies had a risk of bias score ≥75 %, meaning the risk of bias in these five studies was considered low. While 14 of the studies had sample sizes >100 participants, only four studies utilized a prospective design. Bodybuilding had the lowest injury rates (0.12–0.7 injuries per lifter per year; 0.24–1 injury per 1000 h), with strongman (4.5–6.1 injuries per 1000 h) and Highland Games (7.5 injuries per 1000 h) reporting the highest rates. The shoulder, lower back, knee, elbow, and wrist/hand were generally the most commonly injured anatomical locations; strains, tendinitis, and sprains were the most common injury type. Very few significant differences in any of the injury outcomes were observed as a function of age, sex, competitive standard, or bodyweight class.

Conclusion

While the majority of the research we reviewed utilized retrospective designs, the weight-training sports appear to have relatively low rates of injury compared with common team sports. Future weight-training sport injury epidemiology research needs to be improved, particularly in terms of the use of prospective designs, diagnosis of injury, and changes in risk exposure.



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Erratum to: The Effects of Heat Adaptation on Physiology, Perception and Exercise Performance in the Heat: A Meta-Analysis



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A review of e-textiles in neurological rehabilitation: How close are we?

Textiles able to perform electronic functions are known as e-textiles, and are poised to revolutionise the manner in which rehabilitation and assistive technology is provided. With numerous reports in mainstre...

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Firefighter/EMT - Tualatin Valley Fire and Rescue

TUALATIN VALLEY FIRE and RESCUE 11945 SW 70TH AVENUE TIGARD, OREGON 97223 Updated: June 20, 2016 Firefighter/EMT Tualatin Valley Fire & Rescue anticipates requesting the list of applicants in mid-August 2016 and candidates moving forward to the interview step will be provided additional information. Interviews are tentatively scheduled for mid-September 2016. Testing is conducted through National ...

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Firefighter Paramedic - Tualatin Valley Fire and Rescue

TUALATIN VALLEY FIRE and RESCUE 11945 SW 70TH AVENUE TIGARD, OREGON 97223 Updated: June 20, 2016 Firefighter/Paramedic Tualatin Valley Fire & Rescue anticipates requesting the list of applicants in mid-August 2016 and candidates moving forward to the interview step will be provided additional information. Interviews are tentatively scheduled for mid-September 2016. Additional information can be ...

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Spinal Cord Injury - Quality of Life Grief / Loss

Acronym:
SCI-QOL Grief / Loss
Purpose:

The SCI-QOL Grief / Loss instrument assesses the emotional reactions of grief and feelings of loss in response to sustaining a spinal cord injury (SCI).

Description:

The SCI-QOL Grief / Loss instrument is an item response theory (IRT)-calibrated item bank with 17 items that is available for administration as a computer adaptive test (CAT; range 4-12 items) or 9 item short form (SF).

Area of Assessment: Mental Health, Negative Affect, Quality of Life, Stress and Coping
Body Part: Not Applicable
ICF Domain: Body Function
Domain: Emotion
Assessment Type: Patient Reported Outcomes
Length of Test: 05 Minutes or Less
Time to Administer:
<5 Minutes
Number of Items: There are 17 items in the entire item bank. The short form has 9 items. The CAT can present 4-12 items, depending on the user's time vs. accuracy preferences.
Equipment Required:
The Short Form (SF) version requires only the printed form and a pencil. A CAT administration requires a desktop, laptop, or tablet computer with internet connection and login to AssessmentCenter.net.
 
Access to the short form, and administration of CATs through Assessment Center, is available through SCI-QOL@udel.edu.  
Training Required:
SCI-QOL Grief/Loss article (Kalpakjiam et al., 2015) and, if administering CATs, Assessment Center User Manual.
Type of training required: Reading an Article/Manual
Cost: Free
Actual Cost:
Free
Age Range: Adult: 18-64 years, Elderly adult: 65+
Administration Mode: Computer
Diagnosis: Spinal Cord Injury
Populations Tested:
Spinal Cord Injury
Standard Error of Measurement (SEM):
Depends upon mode of administration:
  • Full Item Bank: Mean SEM= 2.18 (Range= 0.16-0.48)
  • 9-Item Short Form: Mean SEM= 0.27 (Range= 0.20 - 0.51)
  • 9-Item Fixed CAT: Mean SEM= 0.25 (Range= 0.19-0.49)
  • Variable-length CAT (Min 8): Mean SEM= 0.56 (Range= 0.20 - 0.49)
  • Variable Length CAT (Min 4): Mean SEM= 0.30 (0.26-0.49) 
Minimal Detectable Change (MDC):
Calculated Using Mean SEM at 95% Confidence Interval:
  • Full Item Bank: MDC= 6.04
  • 9-Item Fixed CAT: MDC= 0.69
  • Variable Length CAT (Min 4): MDC= 0.83
Minimally Clinically Important Difference (MCID):
Not Established
Cut-Off Scores:
Not Established
Normative Data:
(n= 716; Mean Age= 43, SD= 15.3; Time Post Injury= 7.1, SD= 10; 45% Paraplegia, 55% Tetraplegia)
Test-retest Reliability:
Traumatic SCI(Kalpakjian et al., 2015)
  • Excellent: (Pearson's r= 0.84)
  • Excellent: (ICC= 0.83)
Interrater/Intrarater Reliability:
Not Applicable
Internal Consistency:
Traumatic SCI(Kalpakjian et al., 2015)
  • Full Item Bank - Excellent: (Cronbach's alpha= 0.95)
Criterion Validity (Predictive/Concurrent):
Not Established
Construct Validity (Convergent/Discriminant):
Not Established
Content Validity:
Items were derived from focus groups and interviews with individuals with traumatic SCI (n=65) and clinicians who specialize in SCI care (n=42) (Tulsky et al., 2011).
Face Validity:
Not statistically assessed, but all content was generated in collaboration with patients with SCI and expert clinicians, so face validity is believed to be strong.
Floor/Ceiling Effects:
Traumatic SCI(Kalpakjian et al., 2015)
 
Full Item Bank:
  • Floor Effect: Adequate to Excellent (4.8%)
  • Ceiling Effect: Excellent (0.3%)
9-Item Short Form:
  • Floor Effect: Adequate to Excellent (6.2%)
  • Ceiling Effect: Adequate to Excellent (1.4%)
9-Item Fixed Length CAT:
  • Floor Effect: Adequate to Excellent (5.4)
  • Ceiling Effect: Excellent (0.3%)
Variable-length CAT (Min 8):
  • Floor Effect: Adequate to Excellent (4.9%)
  • Ceiling Effect: Excellent (0.3%)
Variable-length CAT (Min 4):
  • Floor Effect: Adequate to Excellent (4.9%)
  • Ceiling Effect: Excellent (0.3%)
Responsiveness:
Not Established
Considerations:
None
Bibliography:
Kalpakjian, C.Z., Tulsky, D.S., Kisala, P.A., & Bombardier, C.H. (2015). Measuring grief and loss after spinal cord injury. Development, validation, and psychometric characteristics of the SCI-QOL Grief and Loss item bank and short form. Journal of Spinal Cord Medicine, 38(3), 347-355.
 
Tulsky, D.S., Kisala, P.A., Victorson, D. Tate, D., Heinemann, A.W., Amtmann, D., & Cella, D. (2011). Developing a contemporary patient-reported outcomes measure for spinal cord injury. Archives of Physical Medicine and Rehabilitation, 92(10), S44-S51.
Year published: 2015
Instrument in PDF Format: Yes


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The effect of resveratrol on angiotensin II levels and the rate of transcription of its receptors in the rat cardiac hypertrophy model

Abstract

This study investigated the effect of resveratrol on serum and cardiac levels of angiotensin II and transcription of its main receptors following pressure overload induced-hypertrophy. Rats were divided into untreated (Hyp) and resveratrol treated hypertrophied groups (H + R). Intact animals served as the control (Ctl). Cardiac hypertrophy was induced by abdominal aortic banding. Blood pressure (BP) was recorded via left carotid artery cannula. Fibrosis was confirmed by Masson trichrome staining. Angiotensin II level was measured using an ELIZA test. Gene expression was assessed by a real time PCR (RT-PCR) technique. We observed that in the H + R group BP and heart weight/body weight were decreased significantly (p < 0.001, p < 0.05, respectively vs Hyp). The cardiac levels of angiotensin II and AT1a mRNA were increased in the Hyp group (p < 0.01 vs Ctl). In the H + R group the AT1a mRNA level was decreased significantly (p < 0.05 vs Hyp). It could be concluded that resveratrol protects the heart against hypertrophy progression in part by affecting cardiac AT1a transcription.



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Aladtec, Inc. Announces Recent Move of Headquarters to River Falls, WI

Relocation to larger office building consolidates two Wisconsin offices and accommodates the company's continued growth. River Falls, Wisconsin - Privately held Aladtec, Inc. announces their move to 387 Arrow Court, River Falls, Wisconsin. After being located in Hudson, Wisconsin for nearly six years, with a satellite office in River Falls, the company chose a larger office space in order to be ...

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Paramedic (Hawaii Licensed) - Remote Medical International

About Us: At Remote Medical International® (RMI), we offer premium medical services to companies across a wide range of industries operating in remote or challenging locations in the US and abroad. Our global team of exceptional medical providers use their skills and expertise to implement leading health and safety initiatives, incorporate preventative health measures, oversee medical evacuations ...

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Dynamic Gait Index

Acronym:
DGI
Purpose:
Assesses individual's ability to modify balance while walking in the presence of external demands
Description:
  • Performed with a marked distance of 20 feet
  • Can be performed with or without an assistive device
  • Scores are based on a 4-point scale:
    • 3 = No gait dysfunction
    • 2 = Minimal impairment
    • 1 = Moderate impairment
    • 0 = Severe impairment
  • Highest possible score is 24 points. Tasks include:
    • Steady state walking
    • Walking with changing speeds
    • Walking with head turns both horizontally and vertically
    • Walking while stepping over and around obstacles
    • Pivoting while walking
    • Stair climbing
Area of Assessment: Balance Vestibular, Balance Non-Vestibular, Functional Mobility, Gait
Body Part: Not Applicable
ICF Domain: Activity
Domain: Motor
Assessment Type: Observer
Length of Test: 06 to 30 Minutes
Time to Administer:
< 10 minutes (may vary with the patient's abilities)
Number of Items: 8
Equipment Required:
  • Shoe box
  • Two obstacles (must be same size)
  • Stairs
  • 20 foot (6.1 meter) pathway
Training Required:
None
Type of training required: No Training
Cost: Free
Actual Cost:
Free
Age Range: Adult: 18-64 years, Elderly adult: 65+
Administration Mode: Paper/Pencil
Diagnosis: Geriatrics, Multiple Sclerosis, Parkinson's Disease, Stroke, Vestibular Disorders
Populations Tested:
  • Brain injury
  • Geriatric
  • Multiple Sclerosis
  • Parkinson's disease
  • Stroke
  • Vestibular disorders
Standard Error of Measurement (SEM):

Community Dwelling Elderly:

 

(Romero et al 2011; n = 42; mean age = 75.6 (range 59-88) years, Community Dwelling Elderly)

 

  • SEM = 1.04 points

Multiple Sclerosis:

 

(Cattaneo et al, 2007; n = 25, mean age = 41.7 (12.5) years; mean time since onset = 8.7 (8.8) years; Italian sample, MS)

 

  • SEM inter-rater reliability = 1.51 points
  • SEM intra-rater relibaility = 2.00 points

Stroke:

 

(Jonsdottir & Cattaneo, 2007, n = 25; mean age = 61.6 (13.1) years; mean time since stroke = 4.2 (7.5) years, range 0.5-35.3 years; Italian sample, Chronic Stroke)

 

  • SEM for inter-rater reliability = 0.97 points 
  • SEM for interrater reliability = 0.94 points

Peripheral Vestibular Disorders:

 

(Calculated from Hall & Herdman, 2006; n = 16; age 51.8 (13.4) years, diagnosis of unilateral or bilateral vestibular hypofunction)

 

  • SEM calculated = 2.8 points
Minimal Detectable Change (MDC):

Chronic Stroke:

(calculated from Jonsdottir and Cattaneo, 2007)

  • MDC (calculated from SEM) = 2.6 points

 

Community Dwelling Elderly:

 

(Romero et al, 2011, Community Dwelling Elderly)

 

  • MDC = 2.9 points

Multiple Sclerosis:

 

(Cattaneo et al, 2007, MS)

 

  • MDC (Calculated from SEM) = 4.19-5.54

Parkinson's Disease:

 

(Huang et al, 2011, n = 72; mean age = 67.5 (11.6); range of disease duration = 2 months-15 years; Hoehn-Yahr range I-III(Stage I = 17, II = 33, III = 22), Taiwanese sample)

 

  • MDC = 2.9 points
  • MDC% = 13.3%

Stroke:

 

(Lin et al, 2010; n = 45; mean age = 60.7 (12.2) years; median time since stroke = 9 months (range 3 to 36 months); Taiwanese sample, Stroke)

 

  • MDC = 4 points
  • Percent change = 16.6%

Vestibular Disorders:

 

(Calculated from Hall & Herdman, 2006, Peripheral Vestibular Disorders)

 

  • MDC calculated = 3.2 points
Minimally Clinically Important Difference (MCID):

Community-dwelling Older adults:

(Pardasaney et al, 2012; n = 111 aged 65 or older; mean age 75.9 + 7 years, 68.5% female)

  • 1.90 points for total sample
  • 1.80 for subjects with DGI scores < 21/24
  • 0.60 for subjects with DGI scores > 21/24
Cut-Off Scores:

Community Dwelling Elderly:

 

(Shumway-Cook et al,1997; n = 44; age > 65, Community Dwelling Elderly)

 

  • < 19 indicative of increased fall risks (Sensitivity 59%, Specificity 64%) 

Community-Dwelling Older Adults:

(Wrisley and Kumar, 2010; n = 35, mean age 72.9 + 7.8 years followed for prospective falls)

  • < 19 indicates increased risk of falls (Sensitivity 67%, specificity 86%)

 

Vestibular Disorders:

(Whitney et al, 2000; n = 247, age 14-95 years, mean 62.4 years, central and peripheral vestibular dysfunction)

 

  • Subjects with scores of < 19/24 are 2.58 times more like to have reported a fall in the previous 6 months than subjects with scores above 19

Multiple Sclerosis:

 

(Cattaneo et al, 2006; n = 51; relapsing-remitting or secondary progressive MS; mean age 45.3 (18.1) years; mean time since onset 15.6 (7.6) years, MS)

 

  • < 12 indicative of fall-risk (Sensitivity 45%, Specificity 80%)

Parkinson's Disease:

(Dibble et al, 2008; total n = 70, mean age = 73.9(6.45), mean J&Y=2.5 (range 1-4), 36 fallers & 34 nonfallers; fallers (n = 36, mean age = 75.25(5.15)), mean duration of PD = 8.32 (8.67), mean modified H&Y=2.5, 28 male/8 female); and non-fallers (n = 34, mean age = 72.50(7.4)), mean duration of PD = 6.49(4.93), mean modified H&Y = 2.0

  • Adequate discriminative ability between fallers and non-fallers based on cutoff score < 19 (sensitivity = 0.64, specificity = 0.85, +LR = 4.26, -LR = 0.42)

(Landers et al 2008, JNPT) (Total n = 49, mean age = 70.9(8.9) yrs, 20 female/29 male; 25 of participants were fallers (mean duration of diagnosis = 75.6(66.9) months, mean UPDRS = 41.8(9.6), mean H&Y = 3.0(0.55)) and 24 participants were non-fallers (mean age = 70.1(6.9) yrs, mean duration since Dx = 45.4(36.9) months, mean UPDRS = 26.8(10.0), mean H&Y = 2.1(0.61)}

  • Adequate discriminative ability between fallers and nonfallers using cut score = 18.5 (AUC = 0.758, Sensitivity = 0.68, Specificity = 0.708, +LR = 2.33, -LR = 0.45; post-test probability = 0.708, Odds ratio 5.20(1.54-17.56) 95%CI)
Normative Data:
Healthy Adults:

(Vereeck et al, 2008; n = 318; mean age = 49.2(18.7), Healthy Adults)

Decade

Mean

SD

5th Percentile

Range

3

24.0

0.2

24

23-24

4

24.0

0.2

24

23-24

5

23.9

0.4

23

22-24

6

23.9

0.4

23

22-24

7

23.2

0.9

21

21-24

8

22.0

2.0

18

13-24

 

Stroke:

(Lin et al, 2010, Acute and Chronic Stroke)

Median Scores for DGI:

1 week

2 months

5 months

Median score

13

14

14

Range: 1st to 3rd quartile

10-18

10-20

11-20

 

(Hwang et al, 2010; n = 11; mean age = 48.09 (5.85) years; mean time post stroke = 24.36 (10.84) months, Chronic Hemiparetic Stroke)

 

Mean DGI Score:
 
Mean
SD
Pretest
10.64
2.01
Posttest
11.64
3.36

 

Parkinson's Disease:

(Cakit et al, 2007; n = 31; mean age 71.8 (6.4) years, Parkinson's Disease)

Mean DGI Score:
 
Mean
SD
Baseline
16.3
5.2
Outcome
16.54
3.35
Test-retest Reliability:

Multiple Sclerosis:

 

(Cattaneo et al, 2007, Multiple Sclerosis)

 

  • Excellent test-retest reliability (ICC = 0.85)

Parkinson's Disease:

 

(Huang et al, 2010, Parkinson's Disease)

 

  • Excellent test-retest reliability (ICC = 0.84)

(Kadivar et al, 2011) (n = 16, age range 59-81 yrs, 5 female/11 males, H&Y stage (range 2-4))

  • Excellent test retest reliability (ICC > 0.99)

Stroke:

 

(Lin et al, 2010; tested in separate sample of 48 patients with chronic stroke; mean age = 54.9 (10.2) years, Acute and Chronic Stroke)

 

  • Excellent test-retest reliability (ICC > 0.94; 0.91-0.97)

(Jonsdottir & Cattaneo, 2007; n = 25 mean age = 61.6 (13.1) years, Chronic Stroke)

 

  • Excellent total score test re-test reliability (ICC = 0.96)
    • Individual items varied from 0.56 (gait and pivot turns) to 1.00 (stair climbing)

Vestibular Population:

 

(Hall et al, 2006; n = 16 patients with vestibular disorders; mean age = 51.8 (13.4) years)

 

  • Excellent test-retest reliability (ICC = 0.86 (total score) (individual items ranged from 0.04-0.90))
Interrater/Intrarater Reliability:

Community Dwelling Older Adults with Baseline Impairment:

 

(Jønsson et al, 2011; n = 24 (Hospital), mean age = 79.4 (6.8) years; n = 26 (outpatient rehabilitation), mean age = 76.8 (6.4) years; assessed at a 1.5 hour interval, rated by 3 PT's at each site; Danish language sample, Community Dwelling Older Adults)

 

Hospital:

  • Excellent intrarater reliability (ICC = 0.90)
  • Excellent interrater reliability (ICC = 0.92)

Outpatient Rehabilitation:

  • Excellent intrarater reliability (ICC = 0.89)
  • Excellent interrater reliability (ICC = 0.82)

Multiple Sclerosis:

 

(McConvey and Bennett, 2005, MS)

 

  • Excellent interrater reliability (ICC = 0.983)
  • Range from r = 0.910-0.976 for individual test terms
  • Excellent intrarater reliability (ICC = 0.760-0.98)

Stroke:

 

(Jonsdottir & Cattaneo, 2007, Chronic Stroke)

 

  • Excellent interrater reliability (ICC = 0.96)

Vestibular:

(Wrisley et al, 2003; n = 30, age range 27-88 years referred for vestibular rehabilitation)

  • Adequate inter-rater reliability (k = 0.64)
Internal Consistency:
Not Established
Criterion Validity (Predictive/Concurrent):

Brain Injury:

(Medley, A. et al, 2006; n = 26; mean age = 41.9 (12.4) years, Brain Injury)

  • Found that a person who scores 19 out of 24 points on the DGI has a 28% probability of falling. A person who scores 24 out of 24 points would have a 6% chance of falling and a person who scores 0 out of 24 points would have a 100% change of falling

(McConvey and Bennet, 2005)

  • Excellent concurrent validity with 6.1m timed walked test (r = -0.81)
Community Dwelling Older Adults:
 
(Shumway-Cook et al, 1997; n = 44; aged 65 to 94 years, Community Dwelling Older Adults)
  • Excellent, Balance Self-Perceptions Test and DGI (r = 0.76)
  • Excellent, Berg Balance Scale and DGI (r = 0.67)
  • Adequate, Assistive Devices History and DGI (r = -0.44)
  • Adequate, History of imbalance and DGI (r = -0.46)
Multiple Sclerosis:
(Cattaneo et al, 2006; Cattaneo et al, 2007, MS)
  • Excellent concurrent validity with the Berg Balance Scale, TUG, DI, and ABC respectively (Spearman coefficient = 0.78, -0.80, -0.54)
  • Poor concurrent validity with the DHI (Spearman coefficient = -0.39)

Parkinson's Disease:

(Cakit et al. 2007; n = 31, mean age = 71.8(6.4), mean duration of PD = 5.58(2.9), mean UPDRS motor subscale = 18.4(9.32))

  • Adequate concurrent validity with UPDRS-motor subscale scores (r = -0.567, p < 0.001)
  • Excellent correlation with history of falls in PD (r = 0.643, p < 0.01)
Stroke:
 
(Jonsdottir and Cattaneo, 2007, Chronic Stroke)
  • Excellent concurrent validity with Berg Balance Scale (r = 0.83)
  • Excellent concurrent validity with the ABC (r = 0.68)

(Lin et al, 2010, Acute and Chronic Stroke)

  • Excellent concurrent validity amongst DGI, 4 itme DGI, and FGA (r > 0.91)
Vestibular Population:
 
(Hall & Herdman, 2006; n = 16 patients with confirmed peripheral vestibular disorders; mean age = 51.8 (13.4) years, Vestibular Population)
  • Berg Balance Scale and DGI scores agreed 63% of the time on fall risk criteria
  • DGI appears to be more sensitive than the Berg Balance Scale in identifying fall risk in patients with vestibular disorders

(Whitney et al. 2000 (n = 30 patients (aged 27 to 88) diagnosed with vestibular disorders, Vestibular Population)

  • Excellent concurrent validity (r = 0.71) between the DGI and the Berg Balance Scale
Construct Validity (Convergent/Discriminant):

Acute and Chronic Stroke:

(Lin et al, 2010)

  • Excellent with the 10 meter walk (r = -0.68, -0.87, -0.83) test and Postural Assessment Scale (r = 0.85, 0.76, 0.83) for Stroke at 1st week of PT, 2 months after PT, and 5 months after PT

Multiple Sclerosis:

(Cattaneo et al, 2006)

  • Statistically significant difference of three points noted between fallers and non-fallers (P = 0.025)

Parkinson's Disease:

(Landers et al, 2008)

  • Significant difference in total DGI scores between fallers (16.1, SD = 3.4) and non-fallers (19.6, SD = 2.6) in PD cohort, p < 0.01

(Dibble et al, 2006; n = 45 with idiopathic PD, mean age = 69.94(11.8), mean duration of PD = 7.43(5.62) years, mean H&Y level = 2.6(0.66); fallers n = 25 and non-fallers n = 20;  faller subgroup characteristics (mean age = 73.25(8.58), mean duration of PD = 9.07(6.13), mean H&Y = 2.95(0.62)); non-faller subgroup characteristics (mean age = 65.91(9.89), mean duration of PD = 5.43(4.25), mean H&Y = 2.17(0.42))

  • Significant difference in DGI scores between fallers {17.92 (4.36) 95% CI = 16.23-19.62} and non-fallers {21.82 (3.42) 95%CI 21.02-22.63
  • Adequate discriminative ability between fallers and non-fallers based on cutoff score = 22 {AUC = 0.84, Sensitivity = 0.89, Specificity = 0.48, +LR = 1.86 (1.38-2.55), -LR = 0.22 (0.10-0.49)
  • Strongest positive LR as compared to Functional Reach test, Berg Balance Test and TUG. Author recommended DGI be administered as first test to detect fall risk in community dwelling persons with PD
Content Validity:
Community-dwelling male veterans:
(Chiu et al, 2006; n = 84, 64-88 years, mean age 75 + 6.47 years)
  • Eash original 4 rating scale categories distinctly identified subjects at different ability levels
  • Clear difficulty hierarchical order
  • 8 items on the DGI appear to represent a single construct
Face Validity:
Not Established
Floor/Ceiling Effects:

Community-dwelling older adults:

(Pardasaney et al, 2012)

  • No floor effect
  • Poor ceiling effect
    • 40% at maximum score at baseline
    • 70% at maximum score after intervention

Multiple Sclerosis:

(Cattaneo et al, 2006, MS)

  • Adequate ceiling effects (7.8%)

Stroke:

(Lin et al, 2010, Acute and Chronic Stroke)

  • Excellent indicates minimal floor effects
  • Adequate indicates relatively little ceiling effects

Floor and Ceiling Effects:

Time Point

Floor Effect %

 Ceiling Effect %

1st week of  PT

2.2

4.4

2 months after PT

0

10.3

5 months after PT

0

11.4

Responsiveness:

Community-dwelling older adults:

(Pardasaney et al, 2012)

  • Poor responsiveness
    • Effect size 0.27
    • Standardized response mean 0.45
    • Only people in the lower balance subgroups demonstrated change scores > MCID

Multiple Sclerosis:

 

(Cattaneo et al, 2006, MS)

 

  • Scores of less than 12 discriminated between fallers and non fallers, however, Cattaneo (2006) reported that the BBS and DGI measures were not as good at discriminating between fallers and non-fallers compared to the Equiscale Test.

Parkinson's Disease:

(Cakit et al, 2007)

  • Was moderately responsive to change (mean change = 4.72 SD = 0.88) in training group following locomotor treadmill training intervention compared to control group (p < 0.05)

(Kadivar et al, 2011)

  • Moderate responsiveness of DGI scores to cued step training with significant differences between the cued and noncued groups (effect size in cued RAS training group = 1.77, in non-cued group = 1.05)

(Landers et al, 2008)

 

  • Sensitivity = 0.680
  • Specificity = 0.708

 

Stroke:

 

(Lin et al, 2010, Acute and Chronic Stroke)

 

  • Moderate responsiveness in depicting change at 2 months and 5 months after therapy (effect size 0.56, 0.62 respectively)
Considerations:
  • Although psychometrics have not been evaluated in SCI population, this measure has been used to assess dynamic balance in 2 SCI studies (Fritz et al, 2011 & Day et al, 2012)
  • FGA shows less ceiling effect and is recommended over DGI is stroke population (Lin et al, 2010)
  • The DGI has a ceiling effect in people with vestibular dysfunction. (Wrisley 2003)

Dynamic Gait Index translations:

Spanish (p5-7):
http://ift.tt/28L18ks

Arabic: The Arabic version of the DGI can be requested for free from alia.alghwiri@gmail.com

These translations, and links to them, are subject to the Terms and Conditions of Use of the Rehab Measures Database. RIC is not responsible for and does not endorse the content, products or services of any third-party website, and does not make any representations regarding its quality, content or accuracy. If you would like to contribute a language translation to the RMD, please contact us at rehabmeasures@ric.org.

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Bibliography:

Badke, M. B., Sherman, J., et al. (2011). "Tongue-based biofeedback for balance in stroke: results of an 8-week pilot study." Arch Phys Med Rehabil 92(9): 1364-1370. Find it on PubMed

Brown, K. E., Whitney, S. L., et al. (2001). "Physical therapy outcomes for persons with bilateral vestibular loss." Laryngoscope 111(10): 1812-1817. Find it on PubMed

Cakit, B. D., Saracoglu, M., et al. (2007). "The effects of incremental speed-dependent treadmill training on postural instability and fear of falling in Parkinson's disease." Clin Rehabil 21(8): 698-705. Find it on PubMed

Cattaneo, D., Jonsdottir, J., et al. (2007). "Reliability of four scales on balance disorders in persons with multiple sclerosis." Disabil Rehabil 29(24): 1920-1925. Find it on PubMed

Cattaneo, D., Regola, A., et al. (2006). "Validity of six balance disorders scales in persons with multiple sclerosis." Disability and Rehabilitation 28(12): 789-795. Find it on PubMed

Chiu, Y. P., Fritz, S. L., et al. (2006). "Use of item response analysis to investigate measurement properties and clinical validity of data for the dynamic gait index." Physical Therapy 86(6): 778-787. Find it on PubMed

Day, K. V., Kautz, S. A., et al. (2012). "Foot placement variability as a walking balance mechanism post-spinal cord injury." Clin Biomech (Bristol, Avon) 27(2): 145-150. Find it on PubMed

Dibble, L. E., Christensen, J., et al. (2008). "Diagnosis of fall risk in Parkinson disease: an analysis of individual and collective clinical balance test interpretation." Physical therapy 88(3): 323-332.

Dibble, L. E. and Lange, M. (2006). "Predicting falls in individuals with Parkinson disease: a reconsideration of clinical balance measures." Journal of Neurologic Physical Therapy 30(2): 60-67.

Fritz, S. L., Pittman, A. L., et al. (2007). "An intense intervention for improving gait, balance, and mobility for individuals with chronic stroke: a pilot study." J Neurol Phys Ther 31(2): 71-76. Find it on PubMed

Hall, C. D. and Herdman, S. J. (2006). "Reliability of clinical measures used to assess patients with peripheral vestibular disorders." J Neurol Phys Ther 30(2): 74-81. Find it on PubMed

Herdman, S. J., Schubert, M. C., et al. (2003). "Recovery of dynamic visual acuity in unilateral vestibular hypofunction." Arch Otolaryngol Head Neck Surg 129(8): 819-824. Find it on PubMed

Huang, S. L., Hsieh, C. L., et al. (2011). "Minimal detectable change of the timed "up & go" test and the dynamic gait index in people with Parkinson disease." Phys Ther 91(1): 114-121. Find it on PubMed

Hwang, S., Jeon, H. S., et al. (2010). "Locomotor imagery training improves gait performance in people with chronic hemiparetic stroke: a controlled clinical trial." Clin Rehabil 24(6): 514-522. Find it on PubMed

Jonsdottir, J. and Cattaneo, D. (2007). "Reliability and validity of the dynamic gait index in persons with chronic stroke." Archives of Physical Medicine and Rehabilitation 88(11): 1410-1415. Find it on PubMed

Jonsson, L. R., Kristensen, M. T., et al. (2011). "Intra- and interrater reliability and agreement of the Danish version of the Dynamic Gait Index in older people with balance impairments." Archives of Physical Medicine and Rehabilitation 92(10): 1630-1635. Find it on PubMed

Kadivar, Z., Corcos, D. M., et al. (2011). "Effect of step training and rhythmic auditory stimulation on functional performance in Parkinson patients." Neurorehabilitation and Neural Repair 25(7): 626-635.

Landers, M. R., Backlund, A., et al. (2008). "Postural instability in idiopathic Parkinson's disease: discriminating fallers from nonfallers based on standardized clinical measures." J Neurol Phys Ther 32(2): 56-61. Find it on PubMed

Lin, J. H., Hsu, M. J., et al. (2010). "Psychometric comparisons of 3 functional ambulation measures for patients with stroke." Stroke 41(9): 2021-2025. Find it on PubMed

McConvey, J. and Bennett, S. E. (2005). "Reliability of the Dynamic Gait Index in individuals with multiple sclerosis." Archives of Physical Medicine and Rehabilitation 86(1): 130-133. Find it on PubMed

Medley, A., Thompson, M., et al. (2006). "Predicting the probability of falls in community dwelling persons with brain injury: a pilot study." Brain Inj 20(13-14): 1403-1408. Find it on PubMed

Pardasaney, P. K., Latham, N. K., et al. (2012). "Sensitivity to change and responsiveness of four balance measures for community-dwelling older adults." Physical therapy 92(3): 388-397.

Romero, S., Bishop, M. D., et al. (2011). "Minimum detectable change of the Berg Balance Scale and Dynamic Gait Index in older persons at risk for falling." Journal of Geriatric Physical Therapy 34(3): 131-137.

Shumway-Cook, A., Baldwin, M., et al. (1997). "Predicting the probability for falls in community-dwelling older adults." Physical Therapy 77(8): 812-819. Find it on PubMed

Shumway-Cook, A., Gruber, W., et al. (1997). "The effect of multidimensional exercises on balance, mobility, and fall risk in community-dwelling older adults." Physical Therapy 77(1): 46-57. Find it on PubMed

Tinetti, M. E. (1986). "Performance-oriented assessment of mobility problems in elderly patients." J Am Geriatr Soc 34(2): 119-126. Find it on PubMed

Tinetti, M. E., Mendes de Leon, C. F., et al. (1994). "Fear of falling and fall-related efficacy in relationship to functioning among community-living elders." J Gerontol 49(3): M140-147. Find it on PubMed

Vereeck, L., Wuyts, F., et al. (2008). "Clinical assessment of balance: normative data, and gender and age effects." Int J Audiol 47(2): 67-75. Find it on PubMed

Whitney, S. L., Hudak, M. T., et al. (2000). "The dynamic gait index relates to self-reported fall history in individuals with vestibular dysfunction." J Vestib Res 10(2): 99-105. Find it on PubMed

Wrisley, D. M. and Kumar, N. A. (2010). "Functional gait assessment: concurrent, discriminative, and predictive validity in community-dwelling older adults." Physical therapy 90(5): 761-773.

Wrisley, D. M., Walker, M. L., et al. (2003). "Reliability of the dynamic gait index in people with vestibular disorders." Arch Phys Med Rehabil 84(10): 1528-1533. Find it on PubMed

Year published: 2001
Instrument in PDF Format: Yes


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Spinal Cord Injury - Quality of Life Stigma

Acronym:

SCI-QOL Stigma

Purpose:

The SCI-QOL Stigma instrument assesses perceptions of prejudice and discrimination in individuals with spinal cord injury.

Description:

The SCI-QOL Stigma measure is an item response theory (IRT)-calibrated item bank with 23 items that is available for administration as a computer adaptive test (CAT; range 4-12 items) or 10 item short form (SF). 5 items were newly generated and 18 items were adapted from the Neuro-QOL measurement scale.

Area of Assessment: Mental Health, Quality of Life, Stress and Coping
Body Part: Not Applicable
ICF Domain: Body Function
Domain: Emotion
Assessment Type: Patient Reported Outcomes
Length of Test: 05 Minutes or Less
Time to Administer:
< 5 Minutes
Number of Items: There are 23 items in the entire item bank. The short form has 10 items. The CAT can present 4-12 items, depending on time and accuracy preferences.
Equipment Required:
The short form requires the form and a pencil. A CAT administration requires a computer with internet connection.
 
Access to the CATs through Assessment Center, is available through SCI-QOL@udel.edu.  
Training Required:
Yes. SCI-QOL Self-esteem article (Kisala et al., 2015) and the Assessment Center User Manual.
Type of training required: Reading an Article/Manual
Cost: Free
Actual Cost:
Free
Age Range: Adult: 18-64 years, Elderly adult: 65+
Administration Mode: Computer
Diagnosis: Spinal Cord Injury
Populations Tested:
Spinal Cord Injury
Standard Error of Measurement (SEM):
Depends upon mode of administration:
  • Full Item Bank: Mean SEM= 0.16 (Range= 0.10-0.54)
  • 10 Item Short Form: Mean SEM= 0.22 (Range= 0.14 to 0.57)
  • 10-Item Fixed CAT: Mean SEM= 0.20 (Range= 0.13-0.55)
  • Variable Length CAT (Min 8): Mean SEM= 0.20 (Range= 0.14 to 0.55)
  • Variable Length CAT (Min 4): Mean SEM= 0.25 (0.19-0.55) 
Minimal Detectable Change (MDC):
Calculated Using Mean SEM:
  • Full Item Bank: MDC= 8.5
  • 10-Item Fixed CAT: MDC= 8.65
  • Variable Length CAT: MDC= 8.45
Minimally Clinically Important Difference (MCID):
Not Established
Cut-Off Scores:
Not Established
Normative Data:

Neurological Disorder: The normative data are calibrated on adults with neurological disorders. The mean (T=50) indicates a score that is normal for an adult with a neurological disorder. (Kisala et al., 2015; n=611, Mean Age= 42.9, SD= 15.5; Time Post Injury= 6.7, SD= 8.7; 44% Paraplegia, 56% Tetraplegia)

Test-retest Reliability:

Traumatic SCI (Kisala et al., 2015; Baseline and 1-2 week retest assessments)

 

Full Item Bank CAT:

  • Excellent: (Pearson's r= 0.80)
  • Adequate: (ICC= 0.79)

10-Item Short Form:

  • Excellent: (Pearson's r= 0.84)
Interrater/Intrarater Reliability:
Not Applicable
Internal Consistency:

Traumatic SCI: (Kisala et al., 2015)

  • Full Item Bank: Excellent (Cronbach's Alpha= 0.94)
  • 10-Item Short Form: Excellent (Cronbach's Alpha= 0.90)
Criterion Validity (Predictive/Concurrent):
Not Established
Construct Validity (Convergent/Discriminant):
Not Established
Content Validity:

Some items were adapted from the Neuro-QOL measurement systems. Other items were derived from focus groups and interviews with individuals with traumatic SCI (n = 65) and clinicians who specialize in SCI (n = 42) (see Tulsky et al., 2011).

Face Validity:
Not statistically assessed, but content was generated from individuals with SCI and expert clinicians; therefore face validity is believed to be strong.  
Floor/Ceiling Effects:
Traumatic SCI(Kisala et al., 2015)
 
Full Item Bank:
  • Floor Effect: Adequate to Excellent (4.26%)
  • Ceiling Effect: Excellent (0.16%)

10-Item Short Form:

  • Floor Effect: Adequate to Excellent (4851%)
  • Ceiling Effect: Excellent (0.16%)

10-Item Fixed Length CAT:

  • Floor Effect: Adequate to Excellent (5.4%)
  • Ceiling Effect: Excellent (0.16%)

Variable-Length CAT (Min 8):

  • Floor Effect: Adequate to Excellent (4.75%)
  • Ceiling Effect: Excellent (0.16%)

Variable Length CAT (Min 4):

  • Floor Effect: Adequate to Excellent (4.75%)
  • Ceiling Effect: Excellent (0.16%)
Responsiveness:
Not Established
Considerations:
None
Bibliography:

Kisala, P. A., Tulsky, D. S., Pace, N., Victorson, D., Choi, S. W., & Heinemann, A. W. (2015). Measuring stigma after spinal cord injury: Development and psychometric characteristics of the SCI-QOL Stigma item bank and short form. Journal of Spinal Cord Medicine, 38(3), 386-396

http://ift.tt/28L1bN7

Tulsky, D. S., Kisala, P. A., Victorson, D., Tate, D., Heinemann, A. W., Amtmann, D., & Cella, D. (2011). Developing a contemporary patient-reported outcomes measure for spinal cord injury. Archives of Physical Medicine and Rehabilitation, 92(10), S44-S51

http://ift.tt/28LvNSp

Year published: 2015
Instrument in PDF Format: Yes


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Spinal Cord Injury – Quality of Life Depression

Acronym:

SCI-QOL Depression

Purpose:
The SCI-QOL Depression instrument assess symptoms of depression in individuals with spinal cord injury.
Description:

The SCI-QOL Depression measure is an item response theory (IRT)-calibrated item bank with 28 items that is available for administration as a computer adaptive test (CAT; range 4-12 items) or short form (SF). Many items are shared with the PROMIS (18 of 28 items) and Neuro-QOL (23 of 28 items) Depression item banks.

Area of Assessment: Depression, Mental Health, Quality of Life
Body Part: Not Applicable
ICF Domain: Body Function
Domain: Emotion
Assessment Type: Patient Reported Outcomes
Length of Test: 05 Minutes or Less
Time to Administer:
<5 Minutes
Number of Items: There are 28 items in the entire item bank. The short form has 10 items. The CAT can present 4-12 items, depending on the user's time vs. accuracy preferences.
Equipment Required:

The Short Form requires only the printed form and a pencil. A CAT administration requires a desktop, laptop, or tablet computer with internet connection and login to AssessmentCenter.net.

Access to the short form, and administration of CATs through Assessment Center, is available through SCI-QOL@udel.edu.

Training Required: Yes. SCI-QOL Depression article (Tulsky et al 2015) and, if administering CATs, the Assessment Center User Manual.
Type of training required: Reading an Article/Manual
Cost: Free
Actual Cost:
Free
Age Range: Adult: 18-64 years, Elderly adult: 65+
Administration Mode: Computer
Diagnosis: Spinal Cord Injury
Populations Tested:
Spinal Cord Injury
Standard Error of Measurement (SEM):
Depends on the mode of administration:
  • Full Item Bank: Mean SEM= 2.1
  • 8-Item Fixed-Length CAT: Mean SEM= 2.7
  • Variable-length CAT (Min 4): Mean SEM= 3.0
  • Variable-length CAT (Min 8): Mean SEM= 3.1
  • 4-Item Fixed-length CAT: Mean SEM= 3.4
Minimal Detectable Change (MDC):
Calculated from SEM
  • Full Item Bank: MDC= 4.9
  • 8-Item Fixed-Length CAT: MDC= 6.3
  • Variable-length : MDC= 7.2
Minimally Clinically Important Difference (MCID):
Not Established
Cut-Off Scores:
Holdnack et al. (in preparation) created a "cross-walk" table to transform SCI-QOL Depression scores to scores on the PHQ-9, a gold standard measure of depression with well-established cut scores. The SCI-QOL Depression scores below are the equivalent of PHQ-9 cutoff scores.
  • Mild Depression: T-score from 52-58
  • Moderate Depression: T-score from 60-64
  • Moderate-severe Depression: T-score from 65-67
  • Severe Depression: T-score 68+
Normative Data:
General population (2000 U.S. Census). The normative data reference the calibration sample from PROMIS, which matches the demographics of the 2000 U.S. Census.
 
(n=716, mean age = 43.0(15.3); time post injury = 7.1 years (10.0); 45% paraplegia, 54% tetraplegia).
Test-retest Reliability:

 Traumatic SCI (Tulsky et al., 2015)

  • Excellent: (Pearson's r= 0.80)
  • Excellent: (ICC= 0.80)
Interrater/Intrarater Reliability:
Not Applicable
Internal Consistency:

Traumatic SCI (Tulsky et al., 2015)

  • Excellent: (Cronbach's alpha= .96)
Criterion Validity (Predictive/Concurrent):
Traumatic SCI (Tulsky et al., 2015)
  • Excellent concurrent validity predicating the PHQ-9 (r= .76)
Construct Validity (Convergent/Discriminant):
Traumatic SCI (Tulsky et al., in preparation)

The SCI-QOL Depression item bank demonstrated good convergent validity by correlating strongly with measures of:

  • Anxiety (GAD-7 r= .59)
  • Life Satisfaction: (Satisfaction with Life Scale r= -.62)
  • Resilience (SCI-QOL Resilience r = -.73)
  • Positive affect (SCI-QOL Positive Affect r= -.68).

The SCI-QOL Depression item bank demonstrated good discriminant validity by weakly correlating with measures of:

  • Fine motor functioning (SCI-QOL Fine Motor r= -.16)
Content Validity:

Some SCI-QOL items were derived from the focus groups and cognitive interviews that founded the PROMIS and/or Neuro-QOL measurement systems. The Neuro-QOL focus groups comprised patients with neurological illness (n=64) and caregivers (n= 19). Other SCI-QOL items were derived from focus groups and interviews with individuals with traumatic SCI (n=65) and clinicians who specialize in SCI (n=42).

Face Validity:

Not statistically assessed, but content was generated from individuals with SCI and expert clinicians, so face validity is believed to be strong.

Floor/Ceiling Effects:
Traumatic SCI (Tulsky et al., 2015)
 
Full Item Bank:
  • Floor Effect: Excellent (0.1%)
  • Ceiling Effect: Adequate to Excellent (3.1%)
8-Item Fixed-length CAT:
  • Floor Effect: Adequate to Excellent (4.7%)
  • Ceiling Effect: Excellent (0.1%)
Variable-length CAT (Max 12):
  • Floor Effect: Adequate to Excellent (3.5%)
  • Ceiling Effect: Excellent (0.1%)
Variable-length CAT (Max 8):
  • Floor Effect: Adequate to Excellent (4.7%)
  • Ceiling Effect: Excellent (0.1%)
4-Item Fixed-length CAT:
  • Floor Effect: Adequate to Excellent (7.4%)
  • Ceiling Effect: Excellent (0.1%)
Responsiveness:
Not Established
Considerations:

None

Bibliography:

Tulsky et al. (2015). Measuring depression after spinal cord injury: Development and psychometric characteristics of the SCI-QOL Depression item bank and linkage with PHQ-9. Journal of Spinal Cord Medicine, 38(3), 335-346.

Year published: 2015
Instrument in PDF Format: Yes


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