Motor, sensory and functional recovery in patients with spinal cord lesions

Abstract

The aim of this study is to evaluate the sensory, motor and functional improvement in patients with a Spinal Cord Lesion (SCL) by recording at admission, discharge and at 12 months after discharge. Fifty-®ve patients (29 with paraplegia and 26 with tetraplegia) admitted to our departments of Physical Medicine and Rehabilitation between December 1992 ± 1995. Three patients were excluded as they did not give their consent. Each patient was evaluated at admission, before discharge and at 12 months after discharge. Motor status was evaluated by the motor score (MS), sensory status by the light touch score (LTS), and functional status by the Functional Independence Measure (FIM) score. Each patient was asked to complete a patient questionnaire which was developed according to the standards of the American Spinal Injury Association (ASIA) scale. Twelve patients (10 with paraplegia and two with tetraplegia) were evaluated at 12 months after discharge. Paired samples t-test was used for statistical analysis. The mean age of the patients group was 36.42+17.70 years, the mean duration of inpatient rehabilitation was 93.87+44.95 days. The SCL was due to trauma in 45 patients, 86.50% of the cases and was complete in nine patients (17.30%) and incomplete in 19 (36.53%) with paraplegia. Six tetraplegic patients (11.53%) had complete and 18 had (34.61%) incomplete lesions. The evaluation of MS, LTS and FIM scores at admission and discharge showed signi®cant improvement in the MS and LTS in all of the patients with incomplete lesions (P50.001). FIM scores showed signi®cant improvement only in those with complete or incomplete paraplegia (P50.05). At 12 months follow-up there was no signi®cant change in the MS and the LTS whereas a signi®cant change was noted in the FIM scores (P50.05) in 10 paraplegic patients. In summary, the results of this study indicate that rehabilitation was e ective in our SCL series although the signi®cant gain may also be attributed to the fact that 71.1% of the study group had incomplete neurological lesions.

Rehabilitation outcomes in traumatic spinal cord injury in Australia: functional status, length of stay and discharge setting

“…The demographic profile of the 167 patients included in this study, namely that they were mostly young, male, single and employed, is consistent with the profiles reported in other studies of patients with spinal cord injury, both overseas 6,13,14 and in Australia. 9,12,15,16 Discharge outcomes: LOS, functional status and discharge setting The documentation of rehabilitation LOS as an outcome measure has escalated in recent decades.…”

“…11 The increase in mean total FIM scores (68.7-102.2) and mean motor FIM scores (35.3-67.3) for the patients from admission to discharge is consistent with the gains documented in other studies. 11,12,14,18 For example, Ditunno et al 18 reported that people with traumatic SCI generally have a mean total FIM score of 59.5 on admission and 95.3 on discharge (mean gain of 35.9), and a mean motor FIM score of 28.6 on admission and 62.1 on discharge (mean gain of 33.5). Data from the United Data System for Medical Rehabilitation (UDSmr) for SCI admissions during 1995-1997, with corresponding sample sizes of 3444, 4337 and 4652 cases, showed lower discharge FIM total scores (means of 89.8 to 88.8 over the 3 years, respectively) and lower FIM gains (mean of 26 for 1997) than patients showed in the present study.…”

Agreement of repeated motor and sensory scores at individual myotomes and dermatomes in young persons with complete spinal cord injury

“…Studies on natural recovery suggest changes in neurological function particularly at NL around the injury. [3][4][5][6] Treatment effectiveness, therefore, may be difficult to ascertain due to typical variation, spontaneous recovery and inadequate outcome measures. 6 The International Standards for Neurological Classification of Spinal Cord Injury (ISCSCI) 7,8 is the standardized method for the evaluation of neurological impairment following SCI.…”

The International Standards for Neurological Classification of Spinal Cord Injury: reliability of data when applied to children and youths

“…[8][9][10][11][12] Others have studied the relationship between motor and sensory scores and bladder recovery, 13 the recovery patterns of muscle strength and sensation in vascular injuries, 14 and the relationship between muscle strength/ motor scores and functional recovery. [15][16][17][18][19][20] The ISCSCI motor and sensory exams have also been used as inclusion criteria for entry into drug and device trials. [21][22][23][24][25][26][27][28] While the work by Bracken 21 added additional upper extremity muscles and variation in the scoring technique, the study used neurological motor level as the primary outcome in the study on high-dose methylprednisolone.…”