A Statistical Method for Analyzing Rating Scale Data: The BBB Locomotor Score

Sanders-Brown Center on Aging, University of Kentucky, Lexington 40536, USA.
Journal of Neurotrauma (Impact Factor: 3.71). 11/2002; 19(10):1251-60. DOI: 10.1089/08977150260338038
Source: PubMed


The Basso, Beattie and Bresnahan (BBB) locomotor rating scale is widely used to test behavioral consequences of spinal cord injury (SCI) to the rat. Sensitivity of this rating scale can differentiate hind limb locomotor skills over a wide range of injury severities. While the 21-point BBB scale is ordinal in nature, the present discussion recommends the use of parametric statistics to evaluate the locomotor results. Specifically, it defines appropriate statistical analysis of these data in order to facilitate interpretation of results between laboratories and to provide a common methodology for the correct interpretation of SCI behavioral data.

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    • "Data are expressed as mean ± standard error of the mean (SEM). Results were analyzed using a two-way ANOVA for repeated measures in the motor recovery experiment [27], and the nonparametric Mann-Whitney U test for: (a) survival of ventral horn and rubrospinal neurons and (b) relative expression of genes. Finally, a Kruskal-Wallis test was used for nitrite and MDA determinations. "
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    ABSTRACT: Monocyte locomotion inhibitory factor (MLIF) is a pentapeptide produced by Entamoeba histolytica that has a potent anti-inflammatory effect. Either MLIF or phosphate buffered saline (PBS) was administered directly onto the spinal cord (SC) immediately after injury. Motor recovery was evaluated. We also analyzed neuroprotection by quantifying the number of surviving ventral horn motor neurons and the persistence of rubrospinal tract neurons. To evaluate the mechanism through which MLIF improved the outcome of SC injury, we quantified the expression of inducible nitric oxide synthase (iNOS), interleukin-10 (IL-10), and transforming growth factor- β (TGF- β ) genes at the site of injury. Finally, the levels of nitric oxide and of lipid peroxidation were also determined in peripheral blood. Results showed that MLIF improved the rate of motor recovery and this correlated with an increased survival of ventral horn and rubrospinal neurons. These beneficial effects were in turn associated with a reduction in iNOS gene products and a significant upregulation of IL-10 and TGF- β expression. In the same way, MLIF reduced the concentration of nitric oxide and the levels of lipid peroxidation in systemic circulation. The present results demonstrate for the first time the neuroprotective effects endowed by MLIF after SC injury.
    Full-text · Article · Nov 2013
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    • "Although the BBB scale uses ordinal scores 22, the use of parametric statistics to evaluate its results has been more recently recommended. This would facilitate interpretation of the results between laboratories and provide a common methodology for behavioral data 23. In addition, Metz et al. "
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    ABSTRACT: Spinal cord injury is an extremely severe condition with no available effective therapies. We examined the effect of melatonin on traumatic compression of the spinal cord. Sixty male adult Wistar rats were divided into three groups: sham-operated animals and animals with 35 and 50% spinal cord compression with a polycarbonate rod spacer. Each group was divided into two subgroups, each receiving an injection of vehicle or melatonin (2.5 mg/kg, intraperitoneal) 5 min prior to and 1, 2, 3, and 4 h after injury. Functional recovery was monitored weekly by the open-field test, the Basso, Beattie and Bresnahan locomotor scale and the inclined plane test. Histological changes of the spinal cord were examined 35 days after injury. Motor scores were progressively lower as spacer size increased according to the motor scale and inclined plane test evaluation at all times of assessment. The results of the two tests were correlated. The open-field test presented similar results with a less pronounced difference between the 35 and 50% compression groups. The injured groups presented functional recovery that was more evident in the first and second weeks. Animals receiving melatonin treatment presented more pronounced functional recovery than vehicle-treated animals as measured by the motor scale or inclined plane. NADPH-d histochemistry revealed integrity of the spinal cord thoracic segment in sham-operated animals and confirmed the severity of the lesion after spinal cord narrowing. The results obtained after experimental compression of the spinal cord support the hypothesis that melatonin may be considered for use in clinical practice because of its protective effect on the secondary wave of neuronal death following the primary wave after spinal cord injury.
    Full-text · Article · Apr 2013 · Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas / Sociedade Brasileira de Biofisica ... [et al.]
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    • "In SCI research, some workers have used parametric statistical methods to analyze raw BBB scores even though this approach is technically incorrect, due to the fact that BBB scores are ordinal in nature. Relying on " the robustness of ANOVA to handle violations of the normality assumption " (Scheff et al., 2002) is less than ideal, and collapsing the scale to force it to be more normal (Ferguson et al., 2004) clouds differences at the upper end of the scale. Here, we used rank transformation prior to the application of standard parametric methods (Conover and Iman, 1981). "
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    ABSTRACT: In spinal cord injury (SCI), block of Sur1-regulated NC(Ca-ATP) channels by glibenclamide protects penumbral capillaries from delayed fragmentation, resulting in reduced secondary hemorrhage, smaller lesions and better neurological function. All published experiments demonstrating a beneficial effect of glibenclamide in rat models of SCI have used a cervical hemicord impact calibrated to produce primary hemorrhage located exclusively ipsilateral to the site of impact. Here, we tested the hypothesis that glibenclamide also would be protective in a model with more extensive, bilateral primary hemorrhage. We studied the effect of glibenclamide in 2 rat cervical hemicord contusion models with identical impact force (10 g, 25 mm), one with the impactor positioned laterally to yield unilateral primary hemorrhage (UPH), and the other with the impactor positioned more medially, yielding larger, bilateral primary hemorrhages (BPH) and 6-week lesion volumes that were 45% larger. Functional outcome measures included: modified (unilateral) Basso, Beattie, and Bresnahan scores, angled plane performance, and rearing times. In the UPH model, the effects of glibenclamide were similar to previous observations, including a functional benefit as early as 24h after injury and 6-week lesion volumes that were 57% smaller than controls. In the BPH model, glibenclamide exerted a significant benefit over controls, but the functional benefit was smaller than in the UPH model and 6-week lesion volumes were 33% smaller than controls. We conclude that glibenclamide is beneficial in different models of cervical SCI, with the magnitude of the benefit depending on the magnitude and extent of primary hemorrhage.
    Full-text · Article · Dec 2011 · Experimental Neurology
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