Arthur Sherwood

International Society for Restorative Neurology

Objectives: To develop an International Spinal Cord Injury (SCI) Musculoskeletal Basic Data Set as part of the International SCI Data Sets to facilitate consistent collection and reporting of basic musculoskeletal findings in the SCI population. Setting: International. Methods: A first draft of an SCI Musculoskeletal Basic Data Set was develop...

Spinal Cord is the official journal of the International Spinal Cord Society. It provides complete coverage of all aspects of spinal injury and disease.

This manuscript summarizes recommendations from the State of the Science Conference in Spinal Cord Injury Rehabilitation 2011. To develop an agenda for spinal cord injury (SCI) rehabilitation research in the next decade. Participants scheduled planning meetings and then gathered at the 2011 joint meeting of the American Spinal Injury Association an...

Objectives: To identify technological advances and that are likely to have a great impact on the quality of life and participation in individuals with spinal cord injury (SCI). Methods: In this paper we use the International Classification of Function to frame a discussion on how technology is likely to impact SCI in 10 years. In addition, we di...

This is a manual that describes the standards for performing neurophysiological assessment of motor control in the arms, legs and trunk of human subjects. It is a multi-muscle surface EMG method that examines relaxation, volitional spasm activation, voluntary movement control, responsiveness to stretch (clinical definition of spasticity) and voliti...

The control of movement provides us with the ability to manipulate and move about within our environment, to satisfy our survival needs and to interact with each other. Motor control is also the process by which we express our sameness and uniqueness within our society. Changes in motor control brought about by damage to our central nervous system,...

Study design: Review by the spinal cord outcomes partnership endeavor (SCOPE), which is a broad-based international consortium of scientists and clinical researchers representing academic institutions, industry, government agencies, not-for-profit organizations and foundations. Objectives: Assessment of current and evolving tools for evaluating...

To understand the everyday life experiences of persons who have spasticity associated with spinal cord injury (SCI). Applied ethnographic design. Patients' homes and rehabilitation clinics. Twenty-four people with SCI who experience spasticity. Not applicable. Domains identified through qualitative analysis of in-depth open-ended interviews. Domain...

Persons with spinal cord injury (SCI) may experience a range of symptoms typically labeled "spasticity." Previous efforts to develop assessment tools that measure spasticity have failed to represent the experiences of persons who live with the condition. The purpose of this multicenter study was to develop an instrument that measures the impact of...

Altered motor control of the shoulder muscles during performance of a specific motor task in patients with shoulder disorders (SDs) has been an interesting subject to researchers. This study compared shoulder muscle activation patterns by surface electromyography (sEMG), including the upper trapezius (UT), lower trapezius (LT), and serratus anterio...

Shoulder dysfunction is common in various patient populations. This investigation was performed to assess shoulder dysfunction with self-report and performance-based functional measures. Fifty men (25 with shoulder dysfunction and 25 without shoulder dysfunction) participated in this study. Self-report functional disabilities were assessed with the...

This chapter presents an overview of the set of symptoms generally classified as spasticity. Definitions of spasticity are reviewed, and this chapter suggests the use of a recently presented definition, “disordered sensori-motor control, resulting from an upper motor neurone lesion, presenting as intermittent or sustained involuntary activation of...

Shoulder-related dysfunction affects individuals' ability to function independently and thus decreases quality of life. Functional task assessment is a key concern for a clinician in diagnostic assessment, outcome measurement, and planning of treatment programs. The purpose of this study was to test the reliability of the FASTRAK 3-dimensional (3-D...

In this study, the reliability of surface electromyographic data (root-mean-square) for volitional motor tasks drawn from a standardized protocol was assessed. For each motor task, 5 s epochs of data were analyzed with a new method to generate a measure called the voluntary response index (VRI). The VRI consists of two components, magnitude and sim...

This study employed neurophysiological methods to relate the condition of the corticospinal system with the voluntary control of lower-limb muscles in persons with motor-incomplete spinal cord injury. It consisted of two phases. In a group of ten healthy subjects, single and paired transcranial magnetic stimulation (TMS) of the motor cortex was use...

Cross-sectional retrospective study of a neurophysiological method of voluntary motor control characterization. This study was undertaken to validate the surface electromyography (sEMG)-based voluntary response index (VRI) as an objective, quantitative, laboratory measure of spinal cord injury severity in terms of voluntary motor control disruption...

The high prevalence of shoulder-related dysfunction has focused increased attention on functional activity assessment. This study (1) tested the reliability of three-dimensional shoulder complex movements during four functional tasks representing different levels of task difficulty, (2) characterized the four functional tasks, and (3) examined the...

In this paper, a method for analyzing surface electromyographic (sEMG) data recorded from the lower-limb muscles of incomplete spinal-cord injured (iSCI) subjects is evaluated. sEMG was recorded bilaterally from quadriceps, adductor, hamstring, tibialis anterior, and triceps surae muscles during voluntary ankle dorsiflexion performed in the supine...

This study was designed to characterize the rudimentary residual lower-limb motor control that can exist in clinically paralyzed spinal-cord-injured individuals. Sixty-seven paralyzed spinal-cord-injured subjects were studied using surface electromyography recorded from muscles of the lower limbs and analyzed for responses to a rigidly administered...

Individuals with incomplete spinal cord injuries (SCI) retain varying degrees of voluntary motor control. The complexity of the motor control system and the nature of the recording biophysics have inhibited efforts to develop objective measures of voluntary motor control. This paper proposes the definition and use of a voluntary response index (VRI...

Objective: To assess methods used to reduce surface electromyographic data during voluntary movements. Design: Retrospective analysis of surface electromyograms recorded from healthy subjects and subjects with spinal cord injury (SCI) using the Brain Motor Control Assessment protocol. Setting: Regional referral center for SCI. Participants: 9 subje...

Ten subjects diagnosed with a spinal cord injury participated in gait training. Six patients were ASIA C and four were ASIA D. Nine were trained using supported treadmill ambulation training (STAT), while one was trained conventionally. Each was trained for twenty minutes, five days per week for three months. Before training, patient motor control...

The purpose of this study was to examine the effects of 3-month gait training on mean gait oxygen consumption (VO2), gait speed (GS), distance covered in a 5-minutes walk, and gait cost (GC). In order to better explain the results, the data were compared to healthy subjects. Ten incomplete SCI patients with mean age 40+/- 14 years participated to t...

To conduct a pilot study of weight-supported ambulation training after incomplete spinal cord injury (SCI), and to assess its safety. Quasiexperimental, repeated measures, single group. Veterans Affairs medical center. Three subjects with incomplete, chronic, thoracic SCIs; 2 classified as D on the American Spinal Injury Association (ASIA) impairme...

Supported Treadmill Ambulation Training (STAT) is a mode of therapy for gait retraining for patients with spinal cord injuries or other upper motor neuron dysfunction. The STAT program involves simultaneously supporting a portion of the patient's weight while gait training on a treadmill. STAT has been successful in improving the gait of many resea...

A prospective double blind cross over trial of intravenous 4-Aminopyridine (4-AP). To determine the efficacy of this drug in the treatment of spinal cord injured (SCI) patients for neurologic impairment, pain and spasticity. The post anesthesia care unit (PACU) of a tertiary care acute hospital. Twelve paraplegic patients were enrolled in a double...

This study of measures of spasticity, or altered motor control, compares the clinically used Ashworth scale with a method based on surface electromyographic (sEMG) recordings called brain motor control assessment (BMCA) in a group of 97 subjects with spinal cord injury (SCI) and varying levels of motor dysfunction. In this paper, we describe how sE...

Restoration of reduced or lost voluntary control after spinal cord injury (SCI) in humans is a key goal of SCI research. Objective methods to assess the degree of remaining motor control are lacking. This study proposes a motor task of alternating ankle movements, monitored by surface electromyography (sEMG) and movement sensors as a means of chara...

Spasticity following spinal cord injury (SCI) is most often assessed clinically using a five-point Ashworth score (AS). A more objective assessment of altered motor control may be achieved by using a comprehensive protocol based on a surface electromyographic (sEMG) activity recorded from thigh and leg muscles. However, the relationship between the...

The aim of the present study was to determine the characteristics of intracortical inhibition in the motor cortex areas representing lower limb muscles using paired transcranial magnetic (TMS) and transcranial electrical stimulation (TES) in healthy subjects. In the first paradigm (n=8), paired magnetic stimuli were delivered through a double cone...

Our serendipitous observations suggested that some patients with spasticity appeared to have improved following the administration of the anticonvulsant drug gabapentin. As some patients with spasticity are either refractory to or intolerant of established medical treatments, we conducted this study to investigate the effect of gabapentin on spasti...

Spasticity following spinal cord injury (SCI) is most often assessed clinically using a five point Ashworth Score (AS). A more objective assessment of altered motor control may be achieved by using a comprehensive protocol based on a surface electromyographic (sEMG) activity recorded from thigh and leg muscles. However, the relation between clinica...

We evaluated the consistency of serial polyelectromyographic recordings of altered motor control in spinal cord injured (SCI) individuals. Using 12 pairs of surface electrodes placed over major muscle groups of lower limb and trunk, we examined voluntary and involuntary and phasic and tonic features of motor control using a standardized protocol fo...

The purpose of this investigation was to study the effectiveness of gabapentin in controlling spasticity in persons with spinal cord injury (SCI) using a surface EMG-based quantitative assessment technique called the brain motor control assessment (BMCA). Six men from a Veterans Affairs Medical Center with spasticity due to traumatic SCI were studi...

We have described motor control in people with different degrees of SCI by using surface polyelectromyographic recordings during single- and multijoint volitional motor tasks. We have shown that neurobiologic conditions of the injured spinal cord can be expressed in two main categories: "new anatomy" and "reduced anatomy". The evidence for a variet...

Stimulation at frequencies from 1 to 50 Hz was applied over the dorsal surface of the lumbar enlargement in spinal cord injury subjects. Low-frequency responses appeared that were similar to compound motor action potentials (CMAPs) evoked by peripheral nerve stimulation. Close examination of the EMG response to higher frequencies (30-50 Hz) reveale...

The brain motor control assessment (BMCA) protocol is a comprehensive multichannel surface EMG recording used to characterize motor control features in persons with upper motor neuron dysfunction. Key information is contained in the overall temporal pattern of motor unit activity, observed in the EMG (RMS) envelope. In paralysis, a rudimentary form...

Vertex transcranial magnetic stimulation (TMS) elicited tibialis anterior motor evoked potentials (MEPs) and silent periods (SPs) that were recorded during and following isometric maximal volitional contraction (MVC). During MVC in 6 healthy subjects, MEP amplitudes in the exercised muscle showed an increasing trend from an initial value of 4539 +/...

The brain motor control assessment (BMCA) protocol is a comprehensive multichannel surface EMG recording used to characterize motor control features in persons with upper motor neuron dysfunction. Key information is contained in the overall temporal pattern of motor unit activity, observed in the EMG (RMS) envelope. In paralysis, a rudimentary form...

To determine the relation between various components of spasticity evaluated clinically in persons with spinal cord injury (SCI). Case series evaluating spasticity using clinical scales commonly referenced in contemporary literature, including the Penn Spasm Frequency Scale, the Ashworth Scale, and standard scales of tendon taps, clonus, and planta...

The results of omental transposition in chronic spinal cord injury have been reported in 160 patients operated upon in the United States, Great Britain, China, Japan, India and Mexico, with detailed outcomes reported in few studies. Recovery of function to a greater degree than expected by natural history has been reported. In this series, 15 patie...

Surface electromyography (sEMG) was used in a group of 100 spinal cord injury (SCI) subjects during a comprehensive protocol to assess the type and severity of their spasticity. Subjects showed the expected range from no spasticity to extreme spasticity with clinical and sEMG criteria. The full range of sEMG responses to passive movement was observ...

A single transcranial magnetic stimulus can evoke two involuntary muscle responses in lower limb muscles of healthy humans. The purpose of the present study was to find out if these responses, when evoked during the processing period of a simple or choice reaction time task, such as ankle dorsiflexion, have specific characteristics related to the t...

Motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (TES) of the motor cortex were recorded in separate sessions to assess changes in motor cortex excitability after a fatiguing isometric maximal voluntary contraction (MVC) of the right ankle dorsal flexor muscles. Five healthy...

Recordings of electrical activity from muscles provides the best means of studying motor control. Quantitation of surface electromyograms (SEMGs) is problematic due to the ill-posed nature of the inverse problem. As a first step towards establishing methods for comparing across muscles and across subjects, the authors examined the repeatability of...

Integrated EMG obtained in a comprehensive examination provides an objective means of assessing spasticity. The authors have compared clinical indices obtained immediately prior to a neurophysiological examination, and found good correlation in spite of the known difficulties in interpreting amplitudes of surface EMG recordings

The differences in the motor performance during different tasks between 19 subjects suffering from SMA and 10 healthy controls were observed. The simultaneous EMG activity of twelve lower limbs and lower trunk muscles was recorded with surface electrodes. EMG data were automatically reduced and compared with data evaluated from performed by physiot...

Transcranial magnetic motor cortex stimulation can elicit a series of responses recorded with different latencies from relaxed muscles of the lower limbs. In 7 healthy subjects, ranging in age from 16 to 62 years, stimulation was delivered by a 9 cm coil centered over Cz with the subject in the supine position. Surface polyelectromyography was used...

The tonic stretch reflex elicited by vibration of a muscle or tendon provides a means of studying segmental reflex activity in humans with impaired volitional motor activity due to spinal cord injury (SCI). Vibration applied to the achilles or patellar tendon in a group of 51 SCI subjects elicited motor unit activity different from that found in 12...

Previous studies of the neurocontrol of movement in spinal cord injury (SCI) subjects revealed that even those without volitional movement may retain some degree of preservation of distal brain influence. We previously defined a discomplete lesion as one which is clinically complete but which is accompanied by neurophysiological evidence of residua...

Seventeen adult, healthy subjects, age 38.4 +/- 0.24 years (mean +/- SEM) 7 of which were females, were studied. Each subject was seated on a specially designed chair with trunk and legs fixed and the foot strapped to a rigid plate that was attached to a load cell. The position of the strap was adjusted so as to lie across the foot at the level of...

Motor control can be studied by characterizing the activity of spinal motor nuclei to brain control, expressed as motor unit activity recordable by surface electrodes. The authors used multichannel recording systems with standardized protocols to accomplish such brain motor control assessment. In this assessment, aspects of preparatory and executiv...

Intracranial compliance, as estimated from a computerized frequency analysis of the intracranial pressure (ICP) waveform, was continuously monitored during the acute postinjury phase in 55 head-injured patients. In previous studies, the high-frequency centroid (HFC), which was defined as the power-weighted average frequency within the 4- to 15-Hz b...

Intracranial pressure (ICP) monitoring is used as an early sign of neurological deterioration in the management of patients with a variety of neurosurgical conditions. Mean ICP is the most commonly used for this purpose; however, mean ICP is a relatively late indicator of many secondary injury processes, and neurological deterioration may occur in...

The trauma of the central nervous system (CNS) can result in the impairment of such brain functions as consciousness, cognitive functions, memory, ability to express through speech, and other forms of volitional motor control of skillful movement. The anatomical basis of the upper motor neuron is much more complex than that of the lower motor neuro...

Having previously demonstrated that residual facilitatory brain influence on segmental structures occurs in paralyzed spinal cord injury patients, we sought evidence of suprasegmental suppression in such patients. By recording EMG activity from leg muscles, we studied changes in segmental excitability of the plantar reflex elicited by cutaneous sti...

Scalp somatosensory evoked potentials (SEPs) were recorded after electrical stimulation of the spinal cord in humans. Stimulating electrodes were placed at different vertebral levels of the epidural space over the midline of the posterior aspect of the spinal cord. The wave form of the response differed according to the level of the stimulating epi...

Three slow wave components, P10, N13 and P18, can be seen in the cervical somatosensory evoked potential (CSEP) in response to median nerve stimulation recorded by an electrode in the epidural space at the dorsal aspect of the cervical spinal cord referenced to an electrode at the suprasternal notch. In the region of high CSEP amplitude, which exte...

Scalp somatosensory evoked potentials (SEPs) were recorded after electrical stimulation of the spinal cord in humans. Stimulating electrodes were placed at different vertebral levels of the epidural space over the midline of the posterior aspect of the spinal cord. The wave form of the response differed according to the level of the stimulating epi...

The effectiveness of spinal cord stimulation for control of spasticity was studied in 59 spinal cord injury patients. SCS was markedly or moderately effective in reducing spasticity in 63% of the patients. We found that control of spasticity by SCS was not correlated with the severity of spasticity, the type of spasticity (flexor or extensor), or t...

We sought neurophysiologic evidence that spinal cord stimulation could modify the behavior of spinal reflexes in 15 chronic SCI patients who showed the beneficial effect of SCS on spasticity. We studied the behavior of passive stretch, clonus, cutaneous touch, plantar reflex irradiation, and the response to the neck flexion reinforcement maneuver d...

Recording the mean intracranial pressure (ICP) as an index of potential herniation has been the standard for intracranial monitoring. The mean intracranial pressure represents only one parameter of a complex control system. The mean ICP may not show variations until late in the course of a pathologic process or may never be elevated despite progres...

In an attempt to demonstrate the presence of functional descending fibers in patients with clinically apparent functional spinal cord transection, we examined electromyographically recorded paralyzed leg muscle responses to the Jendrassik and other reinforcement maneuvers. Two patterns were observed: a low-amplitude, short onset time reinforcement...

In 66 patients who suffered severe spinal cord injury 7 months to 28 years previously, somatosensory cortical evoked potentials were recorded to electrical stimulation of the leg nerves and compared to clinical assessment of light touch, pain, position sense and two-point discrimination. The patients were separated into 4 categories according to th...