Extent of spontaneous motor recovery after traumatic cervical sensorimotor complete spinal cord injury

Abstract

Study design: Retrospective, longitudinal analysis of motor recovery data from individuals with cervical (C4-C7) sensorimotor complete spinal cord injury (SCI) according to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI).Objectives: To analyze the extent and patterns of spontaneous motor recovery over the first year after traumatic cervical sensorimotor complete SCI. Methods: Datasets from the European multicenter study about SCI (EMSCI) and the Sygen randomized clinical trial were examined for conversion of American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade, change in upper extremity motor score (UEMS) or motor level, as well as relationships between these measures. Results: There were no overall differences between the EMSCI and Sygen datasets in motor recovery patterns. After 1 year, up to 70% of subjects spontaneously recovered at least one motor level, but only 30% recovered two or more motor levels, with lesser values at intermediate time points. AIS grade conversion did not significantly influence motor level changes. At 1 year, the average spontaneous improvement in bilateral UEMS was 10-11 motor points. There was only moderate relationship between a change in UEMS and a change in cervical motor level (r 2 ¼ 0.30, Po0.05). Regardless of initial cervical motor level, most individuals recover a similar number of motor points or motor levels. Conclusion: Careful tracking of cervical motor recovery outcomes may provide the necessary sensitivity and accuracy to reliably detect a subtle, but meaningful treatment effect after sensorimotor complete cervical SCI. The distribution of the UEMS change may be more important functionally than the total UEMS recovered.

Motoneuron Death after Human Spinal Cord Injury

“…Recovery of function in two or more spinal segments is less common. 46 The more extensive motoneuron death reported here one level caudal to the lesion epicenter may explain why more recovery is not always apparent clinically, even though this is the level where functional return is expected to occur. Further, the extent of muscle denervation will depend on the longitudinal extent of the lesion, which is unexplored clinically.…”

Can spinal cord injury patients show a worsening in ASIA impairment scale classification despite actually having neurological improvement? The limitation of ASIA Impairment Scale Classification

“…The limitations of using the AIS as an instrument to measure outcomes have been discussed in previous studies and more recent studies have tended to use the AIS grade conversion and motor scores simultaneously, or they have proposed that detecting sensory and motor changes may require more sensitivity than measuring AIS grade conversion, especially when attempting to calculate therapeutic efficacy. 8,9 Many studies in the literature have focused on AIS conversion in SCI patients, but, to the best of our knowledge, only the study by Spiess et al 3 reported a conflict between AIS grade conversion and neurological changes. They reported only 1 out of a total of 90 patients, based on the data from the European Multicenter Study on Human Spinal Cord Injury, was converted from AIS B to AIS D owing to a change in motor level arising from sensorial deterioration without a gain in muscle score.…”

Responsiveness and concurrent validity of the revised Capabilities of Upper Extremity-Questionnaire (CUE-Q) in patients with acute tetraplegia

“…An improvement in many muscles from a motor score of 0 to a score of 1-2 connotes different functional implications than do gains in a few muscles to X3. 12 In addition, a number of the CUE-Q items (reaching out or up) involve shoulder muscles that are not included Figure 1 Scatterplots of total CUE-Q scores and upper extremity motor scores (upper graphs) and self-care FIM scores (lower graphs) at admission and discharge from inpatient rehabilitation. Two subjects had unusual patterns of responses.…”