ASIA impairment scale conversion in traumatic SCI: is it related with the ability to walk? A descriptive comparison with functional ambulation outcome measures in 273 patients

Abstract

Study design: Prospective multicenter longitudinal cohort study. Objectives: To determine the relationship between improvements of the American Spinal Injury Association/International Spinal Cord Society (ASIA/ISCoS) neurological standard scale (AIS) outcome measure and improvements of functional ambulatory outcome measures in patients with traumatic spinal cord injury (SCI). Setting: European multicenter study of human SCI (EM-SCI). Methods: In 273 eligible patients with traumatic SCI, acute (0-15 days) and chronic phase (6 or 12 months) AIS grades, timed up and go (TUG) test and 10-m walk test (10MWT) outcome measurements were analyzed. Subanalysis of those patients who did have AIS conversion was performed to assess its relation with functional ambulatory outcomes. Results: Studied population consisted of 161 acute phase AIS grade A patients; 37 grade B; 43 grade C and 32 acute phase AIS grade D patients. Forty-two patients (26%) converted from AIS grade A, 27 (73%) from grade B, 32 (75%) from grade C and five patients (16%) from AIS grade D. The frequencies of AIS conversions and functional ambulation recovery outcomes were significantly different (Po0.001) in patients with motor complete SCI. The ratio of patients with both recovery of ambulatory function and AIS conversion (n ¼ 101) differed significantly (Po0.001) between the acute phase AIS grade scores; AIS grade A (6/40 patients, 15%), B (9/27 patients, 33%), C (23/29 patients, 79%) and D (5/5 patients 100%). Conclusions: The AIS conversion outcome measure is poorly related to the ability to walk in traumatic SCI patients. Therefore, the authors recommend the use of functional ambulation recovery outcome measures in prognosticating the recovery of walking capacity and performance of patients with SCI.

Structural biomarkers in the cerebrospinal fluid within 24 h after a traumatic spinal cord injury: a descriptive analysis of 16 subjects

“…Finally, although the AIS is a recognizable benchmark for the baseline neurologic assessment of the acute SCI patient, the AIS is a questionable outcome measurement, as it does not address the functional capabilities. 32 As previously mentioned, the diagnostic capabilities of the currently available biomarkers will not exceed that of the initial neurological assessments, so long as they are compared with these neurological assessments as the comparative gold standard. 5 Future studies are needed to determine whether structural biomarkers could be used as diagnostic markers in those SCI patients where a valid baseline neurological assessment cannot be obtained, or if they could better predict long-term outcome than this initial neurological evaluation.…”

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

“…An important starting place for planning a locomotor rehabilitation program is the ability to predict likely future walking ability, as well as to anticipate responsiveness to training, Because AIS conversion between the acute and chronic phases of SCI appears to have little relationship with improvement in walking capacity, 125 a focus on prediction of walking related outcomes is more clinically meaningful than predicting AIS conversion. Of the various measures available to assess walking function, walking speed and distance have been identified as the measures most responsive to change.…”

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

“…In this study, the neurological level of injury (low vs. high cervical) was not a significant predictor of the FI in the logistic regression analysis. This can be explained by the fact that the neurological recovery does not necessarily parallel the functional recovery [20,22].…”