A Clinical Prediction Model for Long-Term Functional Outcome after Traumatic Spinal Cord Injury Based on Acute Clinical and Imaging Factors

Wilson, Jefferson R.; Grossman, Robert G.; Frankowski, Ralph F.; Kiss, Alexander; Davis, Aileen M.; Kulkarni, Abhaya V.; Harrop, James S.; Aarabi, Bizhan; Vaccaro, Alexander R.; Tator, Charles H.; Dvorak, Marcel F.; Shaffrey, Christopher I.; Harkema, Susan J.; Guest, James D.; Fehlings, Michael G.

doi:10.1089/neu.2012.2417

Cited by 162 publications

(137 citation statements)

References 31 publications

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“…Less than 10% of patients reaching complete FI had a motor-complete SCI (AIS A or B) which supports previous work suggesting that the severity of the SCI is the main and most consistent predictor of functional recovery [1,10,13]. Individuals with a motor-incomplete SCI generally present significant higher neurological and functional recovery in comparison with motor-complete SCI [14][15][16].…”

Section: Discussionsupporting

confidence: 85%

“…Trauma severity based on the ISS and the neurological level of injury was not significantly associated with the occurrence of complete FI in the chronic phase after SCI. This regression model has allow us to appreciate that this new 2-level scale has identifies two of the main predictors of functional recovery recognized in the SCI literature [10][11][12][13].…”

Section: Resultsmentioning

confidence: 99%

“…The purpose of this study was first, to describe this new tool, and to investigate its association with four recognized predictive factors of functional outcome (severity and level of the SCI, age and trauma severity) [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

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Determining Complete Functional Independence in Patients with a Traumatic Cervical Spinal Cord Injury: Proposal of a Two-Level Scale Based on the Spinal Cord Independence Measure

Richard-Denis¹,

Thompson²,

Mac-Thiong³

2017

Int J Phys Med Rehabil

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Objective: The SCIM scale is a valid measure of functional outcome for the spinal cord injury (SCI) population, but continuous scores are difficult to translate into functional independence (FI). The purpose of this study was to develop a new tool based on the third version of the SCIM questionnaire that would identify patients reaching complete-FI. In order to confirm that this new scale is relevant, we investigated whether it was associated with four factors often proposed as predictors of chronic functional outcome.Design: A prospective cohort study including 109 patients with cervical traumatic SCI was performed. Based on a minimal score obtained on each item of the SCIM questionnaire, the cohort was dichotomized into complete FI (N=52) or non-complete FI (N=57). Baseline characteristics were compared between the two cohorts. A multivariate logistic regression analysis using age, trauma severity, and neurological characteristics of the SCI was performed.Results: 52.3% of subjects reached complete-FI, sustaining less severe neurological deficits, a lower cervical SCI, and a less severe trauma with decreased associated injuries than non-complete FI patients (p<0.05). Incomplete SCI (AIS grade B, C and D) and younger age were the main predictors of complete FI. Conclusions:This new 2-level functional scale is easily applicable in a clinical setting, may be used retrospectively and provide meaningful information to patients and users on the functional recovery in the chronic phase following cervical SCI.

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Section: Discussionsupporting

confidence: 85%

Section: Resultsmentioning

confidence: 99%

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Determining Complete Functional Independence in Patients with a Traumatic Cervical Spinal Cord Injury: Proposal of a Two-Level Scale Based on the Spinal Cord Independence Measure

Richard-Denis¹,

Thompson²,

Mac-Thiong³

2017

Int J Phys Med Rehabil

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“…56 Imaging and electrophysiological measures associated with walking capacity In recent years, there has been growing interest in identifying electrophysiological and radiographical biomarkers that can predict locomotor outcomes. 60,144,145 Recent evidence from studies of TMS 146 and EMG coherence 60,144 have provided additional support for the importance of corticospinal pathways in human walking. More generally, there is some evidence that magnetic resonance imaging (MRI)-based measures are correlated with impairment.…”

Section: Variables Associated With Walking Functionmentioning

confidence: 99%

Supraspinal Control Predicts Locomotor Function and Forecasts Responsiveness to Training after Spinal Cord Injury

Field-Fote

Yang

Basso

et al. 2017

Journal of Neurotrauma

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Restoration of walking ability is an area of great interest in the rehabilitation of persons with spinal cord injury. Because many cortical, subcortical, and spinal neural centers contribute to locomotor function, it is important that intervention strategies be designed to target neural elements at all levels of the neuraxis that are important for walking ability. While to date most strategies have focused on activation of spinal circuits, more recent studies are investigating the value of engaging supraspinal circuits. Despite the apparent potential of pharmacological, biological, and genetic approaches, as yet none has proved more effective than physical therapeutic rehabilitation strategies. By making optimal use of the potential of the nervous system to respond to training, strategies can be developed that meet the unique needs of each person. To complement the development of optimal training interventions, it is valuable to have the ability to predict future walking function based on early clinical presentation, and to forecast responsiveness to training. A number of clinical prediction rules and association models based on common clinical measures have been developed with the intent, respectively, to predict future walking function based on early clinical presentation, and to delineate characteristics associated with responsiveness to training. Further, a number of variables that are correlated with walking function have been identified. Not surprisingly, most of these prediction rules, association models, and correlated variables incorporate measures of volitional lower extremity strength, illustrating the important influence of supraspinal centers in the production of walking behavior in humans.

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“…Such ability also allows one to determine the efficacy of the care during rehabilitation and modify the treatment to improve outcomes in overall function or on specific tasks. 8 Predicting the rehabilitation potential of SCI subjects Several disability rating scales (Modified Barthel Index, Functional Independence Measure and Spinal Cord Independence Measure) have been proposed and used to evaluate SCI patients on admission and during the course of rehabilitation, assess treatment efficacies and weigh the burden of care. [9][10][11] However, these instruments are unable to assess the disability weighted for the neurological deficit and thus evaluate the independent value of rehabilitation in improving function beyond the effects of neurological recovery, despite its wide acceptance.…”

Section: Discussionmentioning

confidence: 99%

Observational study of the effectiveness of spinal cord injury rehabilitation using the Spinal Cord Injury-Ability Realization Measurement Index

Scivoletto

Bonavita²,

Torre

et al. 2015

Spinal Cord

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Study design: Retrospective observational study. Objectives: The objective of this study was to determine the rehabilitation potential and the extent to which it is realized in a cohort of spinal cord injury patients using the Spinal Cord Injury-Ability Realization Measurement Index (SCI-ARMI) and to study the clinical factors that influence this realization. Setting: Two spinal units in Italy. Methods: Consecutive patients were assessed at the end of an in-patient rehabilitation program using the Spinal Cord Independence Measure and the International Standards for Neurological Classification of Spinal Cord Injury. On the basis of these data and of the age and gender of the patients, we calculated the SCI-ARMI score. Regression analyses were performed to study the relationship between clinical factors and the extent to which rehabilitation potential is realized. Results: We examined the data for 306 patients. Most patients were discharged without having reached their rehabilitation potential, with an SCI-ARMI score o80%. SCI-ARMI scores at discharge were positively influenced by etiology and the lesion level and correlated negatively with lesion severity and the presence of complications during rehabilitation. Conclusion: The SCI-ARMI is an effective tool that can be used to measure the achievement of rehabilitation potential in SCI patients and to identify groups of patients who are at risk of not meeting their rehabilitative potential.

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A Clinical Prediction Model for Long-Term Functional Outcome after Traumatic Spinal Cord Injury Based on Acute Clinical and Imaging Factors

Cited by 162 publications

References 31 publications

Determining Complete Functional Independence in Patients with a Traumatic Cervical Spinal Cord Injury: Proposal of a Two-Level Scale Based on the Spinal Cord Independence Measure

Determining Complete Functional Independence in Patients with a Traumatic Cervical Spinal Cord Injury: Proposal of a Two-Level Scale Based on the Spinal Cord Independence Measure

Supraspinal Control Predicts Locomotor Function and Forecasts Responsiveness to Training after Spinal Cord Injury

Observational study of the effectiveness of spinal cord injury rehabilitation using the Spinal Cord Injury-Ability Realization Measurement Index

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