Neuro Workshop:
Tracks
Plenary Room
| Tuesday, November 5, 2019 |
| 9:55 AM - 11:25 AM |
| Muses North (Plenary Room) |
Overview
The 2019 revision of the International Standards for Neurological Classification of Spinal Cord Injury - What’s new?
Speaker
Dr Ruediger Rupp
Head Of Section Experimental Neurorehabilitation
Heidelberg University Hospital
The 2019 revision of the International Standards for Neurological Classification of Spinal Cord Injury - What’s new?
Abstract
The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) represents the gold standard for determination of the level and severity of an SCI. Over the years, ISNCSCI has undergone several revisions with its eighth edition released in April 2019. The most recent changes include:
1. A new taxonomy for documentation of non-SCI related impairments, such as peripheral nerve injuries, fractures, burns, pain or age-related muscle weaknesses. Previously, the “5*” was foreseen for cases, where the full muscle strength is not achieved, but the examiner thinks that it would be achieved if the non-SCI condition was not present. However, this approach is limited to the motor examination only and the actual examination score is lost unless explicitly documented in the ‘Comments Box.’ To overcome this, a general ‘*’-concept has been introduced where abnormal examination scores can be tagged with a ‘*’ to indicate that non-SCI conditions impacts the examination results. If an examiner tags a score with the ‘*’, details on the reason for this and how this score should be handled during the classification process need to be specified in the ‘Comments box’. While ‘*’-tagged scores above the sensory/motor level will in most cases be handled as normal during classification, ‘*’-tagged scores at or below the motor/sensory level will typically be handled as not normal. Each classification variable resulting in defined levels or ASIA (American Spinal Injury Association) Impairment Scale (AIS) which is affected by the ‘*’-tagged scores, should also be designated with a ‘*’. By this, it is clearly indicated that the classification results are based on clinical interpretation.
2. The Zone of Partial Preservation (ZPP) definition has been refined. In prior ISNCSCI editions, ZPPs were only defined for AIS A injuries, which is not intuitive and restricts the value of ZPPs for effective clinical communication to complete lesions only. Motor ZPPs are now defined and should be documented in all cases including patients with incomplete injuries with absent Voluntary Anal Contraction (VAC). The sensory ZPP on a given side is defined in the absence of sensory function in S4-5 (Light Touch, Pin Prick) on this side as long as Deep Anal Pressure (DAP) is not present.
An analysis of data from the European Multicenter Study about Spinal Cord Injury (EMSCI) found that in one-third of the incomplete patients meaningful ZPPs can be provided with the new definition. A deeper analysis of the EMSCI datasets revealed that the prognosis of the lower extremity motor score after one year is more reliable with the new definition of the ZPP.
This workshop will be an interactive session to get informed about the newest ISNCSCI changes and participants are encouraged to participate in the classification of cases:
1) Changes of the 8th ISNCSCI edition – 5 Mins (R. Rupp)
2) Documentation of non-SCI related impairments – 25 Mins (R. Rupp)
3) New definition of Zones of Partial Preservation – 25 Mins (C. Schuld)
4) Interactive classification of difficult cases – 25 Mins. (S. Kirshblum)
5) General feedback - 10 Mins.
1. A new taxonomy for documentation of non-SCI related impairments, such as peripheral nerve injuries, fractures, burns, pain or age-related muscle weaknesses. Previously, the “5*” was foreseen for cases, where the full muscle strength is not achieved, but the examiner thinks that it would be achieved if the non-SCI condition was not present. However, this approach is limited to the motor examination only and the actual examination score is lost unless explicitly documented in the ‘Comments Box.’ To overcome this, a general ‘*’-concept has been introduced where abnormal examination scores can be tagged with a ‘*’ to indicate that non-SCI conditions impacts the examination results. If an examiner tags a score with the ‘*’, details on the reason for this and how this score should be handled during the classification process need to be specified in the ‘Comments box’. While ‘*’-tagged scores above the sensory/motor level will in most cases be handled as normal during classification, ‘*’-tagged scores at or below the motor/sensory level will typically be handled as not normal. Each classification variable resulting in defined levels or ASIA (American Spinal Injury Association) Impairment Scale (AIS) which is affected by the ‘*’-tagged scores, should also be designated with a ‘*’. By this, it is clearly indicated that the classification results are based on clinical interpretation.
2. The Zone of Partial Preservation (ZPP) definition has been refined. In prior ISNCSCI editions, ZPPs were only defined for AIS A injuries, which is not intuitive and restricts the value of ZPPs for effective clinical communication to complete lesions only. Motor ZPPs are now defined and should be documented in all cases including patients with incomplete injuries with absent Voluntary Anal Contraction (VAC). The sensory ZPP on a given side is defined in the absence of sensory function in S4-5 (Light Touch, Pin Prick) on this side as long as Deep Anal Pressure (DAP) is not present.
An analysis of data from the European Multicenter Study about Spinal Cord Injury (EMSCI) found that in one-third of the incomplete patients meaningful ZPPs can be provided with the new definition. A deeper analysis of the EMSCI datasets revealed that the prognosis of the lower extremity motor score after one year is more reliable with the new definition of the ZPP.
This workshop will be an interactive session to get informed about the newest ISNCSCI changes and participants are encouraged to participate in the classification of cases:
1) Changes of the 8th ISNCSCI edition – 5 Mins (R. Rupp)
2) Documentation of non-SCI related impairments – 25 Mins (R. Rupp)
3) New definition of Zones of Partial Preservation – 25 Mins (C. Schuld)
4) Interactive classification of difficult cases – 25 Mins. (S. Kirshblum)
5) General feedback - 10 Mins.
Biography
Rüdiger Rupp received the Dipl.-Ing. degree in electrical engineering with focus on biomedical engineering and his Ph.D. degree from the Technical University of Karlsruhe, Germany, in 1994 and 2008, respectively. In 2018, he received his venia legendi in Experimental Neurology from Heidelberg University.
After working at the Institute for Biomedical Engineering and Biocybernetics (Prof. G. Vossius) until 1996, since 1997 he is with the Spinal Cord Injury Center (Head: Prof. N. Weidner) of Heidelberg University Hospital, Germany, where he holds the position as the head of the Experimental Neurorehabilitation group.
His main research interests are in the field of rehabilitation engineering for spinal cord injured patients. This includes neuroprosthetics mainly of the upper extremity, man-machine interfaces, gait analysis, development and clinical validation of novel methods and devices for locomotion therapy and realization of software projects for standardized documentation of rehabilitation outcome.
He is author of more than 200 journal, book and conference abstracts and holds two patents. He has been awarded several times for his work and is a member of IEEE, IFESS, VDE, DMGP, DGOOC, SfN, ISCoS and ASIA. Since 2017, he is the chair of ASIA's and ISCoS's International Standard Committee.
