A computerized system for the application of Basso, Beattie and Bresnahan scale in Wistar rats

Molina, Alessandra Eira Iague Sleiman; Cristante, Alexandre Fogaça; Barros Filho, Tarcisio Eloy Pessoa de; Molina, Marcos Sleiman; Molina, Tainá Peral

doi:10.1590/1413-78522015230400673

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Original Articles • Acta ortop. bras. 23 (4) • Jul-Aug 2015 • https://doi.org/10.1590/1413-78522015230400673 copy

A computerized system for the application of Basso, Beattie and Bresnahan scale in Wistar rats

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVES:

To develop and test a computer program to assist researchers in assigning scores in the application of the Basso, Beattie and Bresnahan (BBB) scale and to compare these scores when doing so in free, targeted and automated computer-assisted modes.

METHOD:

To test the program, the participants used the Impactor methodology recommended by the New York University (USA), in which 12 Wistar rats submitted to spinal cord injury were filmed on the 28^th day after the injury. Eight researchers from the Laboratory of Medical Investigation, Faculdade de Medicina da Universidade de São Paulo, SP, Brazil took part in the study. The two heads of the laboratory, with 15 years of experience in the application of the scale, were considered the gold standard.

RESULTS:

The results of the scale application were not significantly different in relation to the gold standard, considering the mean of the evaluators in each method: free, targeted and automated form (with the help of the computer).

CONCLUSIONS:

The application of the BBB scale in the automated mode, using the computer program, did not present any difference in relation to the gold standard for all the evaluators. Level of Evidence II, Diagnostic Studies.

Spine; Methods; Spinal cord compression; Evaluation; Diagnosis, computer-assisted; Rats

Score	Operational definitions of categories and attributes
0	No observable movement of the hindlimbs.
1	Slight (limited) movement of one or two joints, usually hip and/or knee.
2	Extensive movement of one joint or extensive movement of one joint and slight movement of the other.
3	Extensive movement of two joints.
4	Slight movement of all three joints of the hindlimbs.
5	Slight movement of two joints and extensive movement of the third joint.
6	Extensive movement of two joints and slight movement of the third joint.
7	Extensive movement of the three joints in the hindlimbs.
8	Sweeping without weight bearing or plantar support of the paw without weight bearing.
9	Plantar support of the paw with weight bearing only in the support stage (i.e., when static) or occasional, frequent or inconsistent dorsal stepping with weight bearing and no plantar stepping.
10	Plantar stepping with occasional weight bearing and no forelimb-hindlimb coordination.
11	Plantar stepping with frequent to consistent weight bearing and occasional forelimb-hindlimb coordination.
12	Plantar stepping with frequent to consistent weight bearing and occasional forelimb-hindlimb coordination.
13	Plantar stepping with frequent to consistent weight bearing and frequent forelimb-hindlimb coordination.
14	Plantar stepping with consistent weight support, consistent forelimb-hindlimb coordination and predominantly rotated paw position (internally or externally) during locomotion both at the instant of initial contact with the surface as well as before moving the toes at the end of the support stage or frequent plantar stepping, consistent forelimb-hindlimb coordination and occasional dorsal stepping.
15	Consistent plantar stepping, consistent forelimb-hindlimb coordination and no movement of the toes or occasional movement during forward movement of limb; predominant paw position is parallel to the body at the time of initial contact.
16	Consistent plantar stepping and forelimb-hindlimb coordination during gait and movement of the toes occurs frequently during forward movement of the limb; the predominant paw position is parallel to the body at the time of initial contact and curved at the instant of movement.
17	Consistent plantar stepping and forelimb-hindlimb coordination during gait and movement of the toes occurs frequently during forward movement of limb; the predominant paw position is parallel to the body at the time of initial contact and at the instant of movement of the toes.
18	Consistent plantar stepping and forelimb-hindlimb coordination during gait and movement of the toes occurs consistently during forward movement of limb; the predominant paw position is parallel to the body at the time of initial contact and curved during movement of the toes.
19	Consistent plantar stepping and forelimb-hindlimb coordination during gait and movement of the toes occurs consistently during forward movement of limb; the predominant paw position is parallel to the body at the instant of contact and at the time of movement of the toes, and the animal presents a downward tail some or all of the time.
20	Consistent plantar stepping and forelimb-hindlimb coordination during gait and movement of the toes occurs consistently during forward movement of limb; the predominant paw position is parallel to the body at the instant of contact and at the time of movement of toes, and the animal presents consistent elevation of the tail and trunk instability.
21	Consistent plantar stepping and coordinated gait, consistent movement of the toes; paw position is predominantly parallel to the body during the whole support stage; consistent trunk stability; consistent tail elevation
	Definitions
Slight	Partial movement of the joint, below half the range of motion of the joint
Extensive	Partial movement of the joint, above half the range of motion of the joint
Pedaling movement	Rhythmic movement of the hind limb in which its three joints are extended, then fully flexed and once again extended. The animal generally leans sideways, the plantar surface of the paw may or may not touch the ground, no body weight bearing is evident over the entire surface of the rear paw
Without weight bearing	In the contraction of the extensor muscles of the hind limb during plantar stepping of the paw or no thigh elevation
With weight bearing	Contraction of the extensor muscles of the hind limb during plantar stepping of the paw or thigh elevation
Plantar stepping	The paw is in plantar contact with weight bearing, followed by the forward movement of the limb until plantar contact is re-established with weight bearing
Dorsal stepping	The weight is borne by the dorsal surface of the paw at any point of the step cycle
Coordination of the fore and hind limbs	For every step of the fore limb a step is taken with the hind limb and the hind limbs alternate
Occasional	Less than or equal to half of the times, < 50%
Frequent	More than half, but not always, 51- 94%
Consistent	Almost always or always, 95 – 100%
Trunk instability	Lateralization of weight that causes oscillation from one side to another or partial collapse of the trunk

Black rat	Left	Right	Lowest value
11	0	1	0
12	4	4	4
14	1	1	1
15	0	1	0
Blue rat	L	R	Lowest value
3	0	1	0
4	0	1	0
5	4	1	1
6	1	1	1
Green rat	L	R	Lowest value
12	4	1	1
15	11	10	10
16	13	13	13

Program issues score from 0 to 21 Automated Ev. AE	Left side	Answer below
Movement of the hind limb	1. Hip	1. None ( ) Slight ( ) Extensive ( )
	2. Knee	2. None ( ) Slight ( ) Extensive ( )
	3. Ankle	3. None ( ) Slight ( ) Extensive ( )
4. Rhythmic circular movement such as pedaling, either touching the ground or not, but without weight bearing (conditional macro activated if 3 joints with extensive movement)		4. Conditional macro activated if Items 1,2,3 extensive Yes ( ) No ( )
5. Plantar support		5. Yes ( ) No ( )
6. Weight bearing		6. None ( ) Occasional < 50% ( ) Frequent 51 to 94% ( ) Consistent 95 to 100% ( )
7. Dorsal stepping (= step)		7. None ( ) Occasional < 50% ( ) Frequent 51 to 94% ( ) Consistent 95 to 100% ( )
8. Plantar stepping		8. None ( ) Occasional < 50% ( ) Frequent 51 to 94% ( ) Consistent 95 to 100% ( )
9. Coordination of fore leg stepping with hind leg stepping		9. None ( ) Occasional < 50% ( ) Frequent 51 to 94% ( ) Consistent 95 to 100% ( )
10. Detach toes		10. None ( ) Occasional < 50% ( ) Frequent 51 to 94% ( ) Consistent 95 to 100% ( )
11. Position paw initial contact		11. Internal rotation ( ) External rotation ( ) Parallel ( )
12. Elevation of paw		12. Internal rotation ( ) External rotation ( ) Parallel ( )
13. TAIL *down: tail touches the ground during steps		13. Lowered all the time ( ) Lowered most of the time ( ) Raised ( )
14. Trunk instability		Yes ( ) No ( )
Name of researcher Rat Color

Comparison between the automated method and the gold standard
	Automated	Gold standard	p-value
Evaluator 1
Mean (SD)	2.09 (3.3)	2.82 (4.49)	0.7335*
Median	1	1
Minimum – Maximum	0 – 9	0 - 13
Total	11	11
Evaluator 2
Mean (SD)	2 (3.35)	2.82 (4.49)	0.5580*
Median	1	1
Minimum – Maximum	0 - 12	0 - 13
Total	11	11
Evaluator 3
Mean (SD)	4 (4.47)	2.82 (4.49)	0.0760*
Median	1	1
Minimum – Maximum	1 - 13	0 - 13
Total	11	11
Evaluator 4
Mean (SD)	2.18 (3.87)	2.82 (4.49)	0.4911*
Median	1	1
Minimum – Maximum	0 - 13	0 - 13
Total	11	11
Evaluator 5
Mean (SD)	2.18 (2.79)	2.82 (4.49)	0.6845*
Median	1	1
Minimum – Maximum	0 - 10	0 - 13
Total	11	11
Evaluator 6
Mean (SD)	4.36 (4.39)	2.82 (4.49)	0.1583*
Median	3	1
Minimum - Maximum	0 - 13	0 - 13
Total	11	11
Comparison between the targeted method and the gold standard.
	Targeted	Gold standard	p-value
Evaluator 1
Mean (SD)	2.91 (4.32)	2.82 (4.49)	0.4784*
Median	1	1
Minimum - Maximum	0 - 12	0 - 13
Total	11	11
Evaluator 2
Mean (SD)	2.18 (3.95)	2.82 (4.49)	0.9416*
Median	1	1
Minimum – Maximum	0 - 14	0 - 13
Total	11	11
Evaluator 3
Mean (SD)	5 (4.65)	2.82 (4.49)	0.0836*
Median	5	1
Minimum – Maximum	1 - 15	0 - 13
Total	11	11
Evaluator 4
Mean (SD)	3.09 (4.99)	2.82 (4.49)	0.3441*
Median	1	1
Minimum – Maximum	0 - 17	0 - 13
Total	11	11
Evaluator 5
Mean (SD)	2.91 (3.21)	2.82 (4.49)	0.9163*
Median	2	1
Minimum – Maximum	0 - 10	0 - 13
Total	11	11
Evaluator 6
Mean (SD)	5.73 (5.27)	2.82 (4.49)	0.0145†
Median	3	1
Minimum – Maximum	0 - 14	0 - 13
Total	11	11
Comparison between the free method and the gold standard
	Free	Gold standard	p-value
Evaluator 1
Mean (SD)	2.45 (3.75)	2.82 (4.49)	0.3653*
Median	1	1
Minimum - Maximum	0 - 12	0 - 13
Total	11	11
Evaluator 2
Mean (SD)	2 (2.79)	2.82 (4.49)	0.3428*
Median	1	1
Minimum - Maximum	0 - 10	0 - 13
Total	11	11
Evaluator 3
Mean (SD)	4.27 (4.03)	2.82 (4.49)	0.1361*
Median	1	1
Minimum - Maximum	1 - 11	0 - 13
Total	11	11
Evaluator 4
Mean (SD)	4.55 (5.09)	2.82 (4.49)	0.0368*
Median	2	1
Minimum - Maximum	0 - 17	0 - 13
Total	11	11
Evaluator 5
Mean (SD)	2 (3.38)	2.82 (4.49)	0.5961*
Median	1	1
Minimum – Maximum	0 - 12	0 - 13
Total	11	11
Evaluator 6
Mean (SD)	5.64 (5.16)	2.82 (4.49)	0.0115†
Median	3	1
Minimum - Maximum	0 - 14	0 - 13
Total	11	11

Mean of the Evaluators	Automated	Gold standard	p-value
Mean (SD)	2.8 (2.88)	2.82 (4.49)	0.5147*
Median	1.5	1
Minimum – Maximum	0.5 - 9.83	0 - 13
Total	11	11
Mean of the Evaluators	Targeted	Gold standard	p-value
Mean (SD)	3.64 (3.42)	2.82 (4.49)	0.0856*
Median	2	1
Minimum - Maximum	0.33 - 10	0 – 13
Total	11	11
Mean of the Evaluators	Free	Gold standard	p-valor
Mean (SD)	3.48 (3.34)	2.82 (4.49)
Median	1.67	1	0.2132*
Minimum - Maximum	0.5 - 10.83	0 - 13
Total	11	11

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