Cross-cultural Adaptation of Self-report S4-5 Sensory and Motor Function Questionnaire (S4-5Q) in People with Spinal Cord Injury to Portuguese / Adaptação transcultural para o Português do questionário de autorrelato da função sensorial e motora de S4-5 (S4-5Q) em pessoas com lesão medular espinhal

Abstract Objective The "Self-report S4-5 sensory and motor function questionnaire (S4-5Q)" is a short questionnaire that aims to assess the function of the sacral segments, S4 and S5, after a spinal cord injury (SCI), with the purpose of replacing the rectal exam test. The aim of the present study was to carry out a cross-cultural adaptation of the S4-5Q to the Brazilian Portuguese language and to investigate the test-retest reliability of this version. Method The translation and cross-cultural adaptation was performed using the methodology of translation and backtranslation. Initially, translations were done by three independent translators. Their synthesis was then submitted to an expert committee for analysis (SCI health professionals); then, the backtranslation to the original language was sent to the original author and, after all the adjustments, the final version was completed. For test-retest reliability, 24 individuals with chronic SCI were recruited (2 evaluations with an interval of 7 to 14 days between them). Statistical analysis was performed using IBM-SPSS (Version 20, SPSS Inc, Chicago, IL, USA) with data pretabulated in Microsoft Excel (Microsoft Corporation, Redmond, WA, USA). Reliability was tested with Cohen Kappa, and internal consistency with Cronbach α, both adopting p < 0.05 as significant. Results In the reliability analysis, the results of all questions showed almost perfect agreement (Kappa > 0.81) and good internal consistency (Cronbach α: 0.65-0.77) between the questions and final classification. Conclusion The cross-culturally adapted S4-5Q is reliable to be applied to the Brazilian population with chronic SCI to determine their S4-5 sensory and motor function.

Resumo Objetivo O "Self-report S4-5 Sensory and Motor Function Questionnaire (S4-5Q)" é um breve questionário de avaliação da função dos segmentos sacrais S4 e S5 após uma lesão medular (LM), cuja finalidade é substituir o exame de toque retal. O objetivo do presente estudo foi realizar uma adaptação transcultural do questionário S4-5Q para a língua portuguesa do Brasil e investigar a confiabilidade teste-reteste desta versão. Método A tradução e a adaptação transcultural foram realizadas utilizando a metodologia de tradução e retrotradução. Inicialmente, as traduções foram realizadas por três tradutores independentes. Sua síntese foi então submetida a um comitê de especialistas (profissionais de saúde com experiência em LM). Em seguida, a retrotradução para o idioma original foi enviada ao autor original, sendo que a versão final foi concluída após todas as adaptações. Para a confiabilidade teste-reteste, foram recrutados 24 indivíduos com lesão medular espinal (LME) em fase crônica (2 avaliações com intervalo de 7 a 14 dias entre elas). A análise estatística foi realizada no IBM-SPSS (Version 20, SPSS Inc, Chicago, IL, USA) com dados pré- tabulados no programa Microsoft Excel (Microsoft Corporation, Redmond, WA, EUA). A confiabilidade foi testada por meio do coeficiente Kappa de Cohen, e a consistência interna foi medida através do α de Cronbach, ambas adotando p < 0,05 como significante. Resultados Na análise de confiabilidade, os resultados de todas as perguntas apresentaram concordância quase perfeita (Kappa > 0,81) e boa consistência interna (α de Cronbach: 0,65-0,77) entre as perguntas e a classificação final. Conclusão O questionário S4-5Q adaptado culturalmente é confiável, podendo ser aplicado à população brasileira com LME crônica, com o objetivo de avaliar a função sensorial e motora nos segmentos sacrais S4-S5.

Tradução e adaptação transcultural da versão brasileira da Spinal Cord Independence Measure - Self-Reported Version (brSCIM-SR) / Translation and cross-cultural adaptation of the Brazilian version of the Spinal Cord Independence Measure - Self-Reported Version (brSCIM-SR)

OBJETIVO: O objetivo deste estudo foi realizar a validação transcultural de um instrumento de autorrelato utilizado para avaliar o nível de independência funcional nas atividades de vida diária em pessoas com lesão da medula espinal (LME), a Spinal Cord Independence Measure? Self-Reported Version (SCIM-SR) para a língua portuguesa do Brasil. MÉTODOS: Duas traduções independentes da versão original do instrumento em inglês e síntese de uma versão em português foram realizadas, seguidas pela consulta de um painel de profissionais de reabilitação e confecção da versão pré-final, pré-teste (n = 13), retrotradução para a língua original e aprovação da autora original do instrumento. RESULTADOS: A comparação do instrumento original com a retrotradução e aprovação garantiu que a equivalência semântica e a manutenção do conteúdo do instrumento tenham sido adequadamente mantidas. CONCLUSÃO: A brSCIM-SR foi adequadamente validada transculturalmente ao português e pode ser utilizada como um instrumento de autorrelato para avaliar o nível de indepen-dência das pessoas com LME no Brasil.

OBJECTIVE: The objective of this study was to do the cross-cultural validation of a self-reported instrument used to evaluate the functional independence in the activities of daily living in people with spinal cord injury (SCI), the Spinal Cord Independence Measure? Self-Reported Version (SCIM-SR) into Portuguese of Brazil. METHODS: Two independent translations of the original version in English and the synthesis of a Portuguese version has been made, followed by a panel consensus of rehabilitation professionals and confection of a prefinal version, pretest (n = 13), back-translation to the English and original instrument author approval. RESULTS: The comparison of the original with the back-translation version and its approval ensured that the semantic equivalence and the content of the instrument were maintained. CONCLUSION: The brSCIM-SR was cross-culturally validated to the Portuguese and can be used as a self-report instrument to assess the level of independence in people with SCI in Brazil.

Exercise alleviates hypoalgesia and increases the level of calcitonin gene-related peptide in the dorsal horn of the spinal cord of diabetic rats

OBJECTIVE: The aim of this study was to evaluate the effects of treadmill training on nociceptive sensitivity and immunoreactivity to calcitonin gene-related peptide in the dorsal horn of the spinal cord of diabetic rats. METHODS: Male Wistar rats were divided into three groups: control, diabetic and trained diabetic. Treadmill training was performed for 8 weeks. The blood glucose concentrations and body weight were evaluated 48 h after diabetes induction and every 30 days thereafter. The nociceptive sensitivity was evaluated using the tail-flick apparatus. The animals were then transcardially perfused, and the spinal cords were post-fixed, cryoprotected and sectioned in a cryostat. Immunohistochemistry for calcitonin gene-related peptide analysis was performed on the dorsal horn of the spinal cord. RESULTS: The nociceptive sensitivity analysis revealed that, compared with the control and trained diabetic animals, the latency to tail deflection on the apparatus was longer for the diabetic animals. Optical densitometry demonstrated decreased calcitonin gene-related peptide immunoreactivity in the dorsal horn of the spinal cord in diabetic animals, which was reversed by treadmill training. CONCLUSION: We concluded that treadmill training can alleviate nociceptive hypoalgesia and reverse decreased calcitonin gene-related peptide immunoreactivity in the dorsal horn of the spinal cord of diabetic animals without pharmacological treatment.

Thermographic evaluation of hind paw skin temperature and functional recovery of locomotion after sciatic nerve crush in rats

INTRODUCTION: Peripheral nerves are often damaged by direct mechanical injury, diseases, and tumors. The peripheral nerve injuries that result from these conditions can lead to a partial or complete loss of motor, sensory, and autonomic functions, which in turn are related to changes in skin temperature, in the involved segments of the body. The aim of this study was to evaluate the changes in hind paw skin temperature after sciatic nerve crush in rats in an attempt to determine whether changes in skin temperature correlate with the functional recovery of locomotion. METHODS: Wistar rats were divided into three groups: control (n = 7), sham (n = 25), and crush (n = 25). All groups were subjected to thermographic, functional, and histological assessments. RESULTS: ΔT in the crush group was different from the control and sham groups at the 1st, 3rd and 7rd postoperative days (p<0.05). The functional recovery from the crush group returned to normal values between the 3rd and 4th week post-injury, and morphological analysis of the nerve revealed incomplete regeneration at the 4th week after injury. DISCUSSION: This study is the first demonstration that sciatic nerve crush in rats induces an increase in hind paw skin temperature and that skin temperature changes do not correlate closely with functional recovery.

Beneficial effects of treadmill training in experimental diabetic nerve regeneration

OBJECTIVES: We investigated the effects of treadmill training (10 weeks) on hindlimb motor function and nerve morphometric parameters in diabetic rats submitted to sciatic nerve crush. MATERIALS AND METHOD: Wistar rats (n = 64) were divided into the following groups: non-diabetic; trained non-diabetic; non-diabetic with sciatic nerve crush; trained non-diabetic with sciatic nerve crush; diabetic; trained diabetic; diabetic with sciatic nerve crush or trained diabetic with sciatic nerve crush. Diabetes was induced by streptozotocin injection (50 mg/kg, iv). Hindlimb motor function was evaluated weekly by assessing sciatic functional indices, and the proximal and distal portions of the sciatic nerve were used for morphometric analysis. RESULTS: At 13 weeks post-injury, the distal nerve portion of all injured groups and the proximal nerve portion of the diabetic with sciatic nerve crush group presented altered morphometric parameters such as decreased myelinated fiber diameter (~7.4 + 0.3μm vs ~4.8 + 0.2μm), axonal diameter (~5 + 0.2μm vs ~3.5 + 0.1μm) and myelin sheath thickness (~1.2 + 0.07μm vs ~0.65 + 0.07μm) and an increase in the percentage of area occupied by endoneurium (~28 + 3 percent vs ~60 + 3 percent). In addition, in the non-diabetic with sciatic nerve crush group the proximal nerve portion showed a decreased myelinated fiber diameter (7.4+0.3μm vs 5.8 + 0.3μm) and myelin sheath thickness (1.29 + 0.08μm vs 0.92 + 0.08μm). The non-diabetic with sciatic nerve crush, trained non-diabetic with sciatic nerve crush, diabetic with sciatic nerve crush and trained diabetic with sciatic nerve crush groups showed normal sciatic functional index from the 4th,4th,9th and 7th week post-injury, respectively. Morphometric alterations in the proximal nerve portion of the diabetic with sciatic nerve crush and non-diabetic with sciatic nerve crush groups were either prevented or reverted to values similar to the non-diabetic group by treadmill training. CONCLUSION: Diabetic condition promoted delay in sciatic nerve regeneration. Treadmill training is able to accelerate hindlimb motor function recovery in diabetic injured rats and prevent or revert morphometric alterations in proximal nerve portions in non-diabetic and diabetic injured rats.