Video training and certification program improves reliability of postischemic neurologic deficit measurement in the rat.

Abstract

Scoring systems are used to measure behavioral deficits in stroke research. Video-assisted training is used to standardize stroke-related neurologic deficit scoring in humans. We hypothesized that a video-assisted training and certification program can improve inter-rater reliability in assessing neurologic function after middle cerebral artery occlusion in rats. Three expert raters scored neurologic deficits in post-middle cerebral artery occlusion rats using three published systems having different complexity levels (3, 18, or 48 points). The system having the highest point estimate for the correlation between neurologic score and infarct size was selected to create a video-assisted training and certification program. Eight trainee raters completed the video-assisted training and certification program. Inter-rater agreement ( Κ: score) and agreement with expert consensus scores were measured before and after video-assisted training and certification program completion. The 48-point system correlated best with infarct size. Video-assisted training and certification improved agreement with expert consensus scores (pretraining = 65 ± 10, posttraining = 87 ± 14, 112 possible scores, P < 0.0001), median number of trainee raters with scores within ±2 points of the expert consensus score (pretraining = 4, posttraining = 6.5, P < 0.01), categories with Κ:  > 0.4 (pretraining = 4, posttraining = 9), and number of categories with an improvement in the Κ: score from pretraining to posttraining (n = 6). Video-assisted training and certification improved trainee inter-rater reliability and agreement with expert consensus behavioral scores in rats after middle cerebral artery occlusion. Video-assisted training and certification may be useful in multilaboratory preclinical studies.

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Citation

Published Version (Please cite this version)

10.1177/0271678x15616980

Publication Info

Taninishi, Hideki, Molly Pearlstein, Huaxin Sheng, Miwa Izutsu, Rafael E Chaparro, Larry B Goldstein and David S Warner (2016). Video training and certification program improves reliability of postischemic neurologic deficit measurement in the rat. Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism, 36(12). pp. 2203–2210. 10.1177/0271678x15616980 Retrieved from https://hdl.handle.net/10161/23260.

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Scholars@Duke

Sheng

Huaxin Sheng

Associate Professor in Anesthesiology

We have successfully developed various rodent models of brain and spinal cord injuries in our lab, such as focal cerebral ischemia, global cerebral ischemia, head trauma, subarachnoid hemorrhage, intracerebral hemorrhage, spinal cord ischemia and compression injury. We also established cardiac arrest and hemorrhagic shock models for studying multiple organ dysfunction.  Our current studies focus on two projects. One is to examine the efficacy of catalytic antioxidant in treating cerebral ischemia and the other is to examine the efficacy of post-conditioning on outcome of subarachnoid hemorrhage induced cognitive dysfunction.

Eduardo Chaparro

Research Scholar

Dr. Chaparro received his Medical Doctoral degree from Javeriana University in Bogota - Colombia and his Ph.D. in Medical Sciences with a focus on Physiology, Pharmacology, and Neuroscience from the University of South Florida in Tampa - Florida. He joined the Anesthesiology Department at USF for his graduate work to study the effects of anesthetics and anti-apoptotic compounds in brain ischemia. After completing his Ph.D., he came to Duke University for his post-doctoral training at the Multidisciplinary Neuroprotection Laboratory where he dedicated his time to testing drugs and devices in different animal models of neurological conditions getting special recognition for successfully testing the first hepatocyte growth factor mimetic in an animal model of transient cerebral ischemia. He also successfully tested a vestibular stimulator approved by the FDA for human use. After completing his post-doctoral training, Dr. Chaparro joined the Cerebrovascular and Skull Base Division at the Duke University Department of Neurosurgery where he has dedicated his career to testing treatments for neurovascular conditions including stroke, moyamoya disease, aneurysms, intra-cerebral hemorrhages, intravascular stent thrombogenicity, traumatic brain injury, and epilepsy. Dr. Chaparro is also an entrepreneur, and his interest in hypothermia as a treatment for neuronal inflammation, let him patent a brain-cooling device that has been successfully tested in non-human primates. He assembles a team of engineers, neuroscientists, and business experts to create Neurocool, a startup to develop the prototype further. As a CEO he is working on getting FDA approval and developing a human-compatible device aiming to help patients with central nervous system inflammatory conditions.

Goldstein

Larry Bruce Goldstein

Adjunct Professor of Neurology

General Research Focus: Cerebrovascular Disease/Stroke. Research efforts have involved several aspects of cerebrovascular disease. In the laboratory, work has centered on developing an understanding of the mechanisms underlying pharmacological modulation of motor recovery after injury to the cerebral cortex and has led to several clinical studies in patients with stroke and traumatic brain injury. Research in stroke has also focused on health policy issues related to the use of carotid endarterectomy and optimization of stroke prevention strategies. Research involving new therapies for acute stroke has been carried out through clinical trials. Current focus is on identifying genes associated with small-vessel type stroke.

Specific Approaches: Laboratory Research: Studies of recovery after sensorimotor cortex injury have focused on measurement of neurobehavioral recovery as influenced by systemically administered drugs modulating the activities of specific central neurotransmitters. This work has involved behavioral measures, stereotactic lesioning, basic neurochemistry, cerebral microdialysis, and immunocytochemistry. Health Policy Research: Work has focused on clinical health policy related to cerebrovascular disease carried out in conjunction with the Center for Clinical Health Policy Research. These studies have centered on the utilization of carotid endarterectomy and the optimization of secondary and tertiary stroke prevention with an emphasis on outcome measures.

Clinical Trials: Principal investigator at Duke for several stroke acute treatment trials including studies of GM1-ganglioside and several neuroprotective drugs including CGS-19755 (Selfotel), Eliprodil, and a glycine receptor antagonist. Principal or co-investigator at Duke for several stroke prevention trials including the NIH-supported study of carotid angioplasty and stenting as compared with carotid endarterectomy (CREST), RESPECT (PFO closure), PROfESS (antiplatelet drugs and angiotensin receptor blocker). In addition, principal investigator for NIH-supported studies related to poststroke recovery and steering committee for SPARCL (statin for secondary stroke prevention).

Special Expertise: Effects of drugs on recovery after stroke and brain injury
Neuroplasticity and behavioral recovery after brain injury
Stroke trial design and outcomes measures
Carotid endarterectomy/ angioplasty-stenting
Stroke prevention (primary and secondary)
Stroke-related health policy and outcomes


Key Words: Neurorehabilitation, stroke, cerebrovascular disease, neurobehavior, carotid endarterectomy, angioplasty, health services, prevention, outcomes


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