Effects on age on spinal cord lesion patients' rehabilitation

Abstract

Study design: The present study was undertaken to focus the age-related characteristics of a population of traumatic and nontraumatic spinal cord patients. Objectives: to examine demographic, injury and outcome characteristics of older adults with spinal cord lesions as a result of trauma and nontrauma, and to compare these characteristics with those of younger patients in matched cohorts. Setting: Spinal Cord Unit, Fondazione Santa Lucia IRCCS, a large rehabilitation hospital of the centre-south of Italy. Methods: In total, 284 consecutive newly injured patients with traumatic and nontraumatic spinal cord lesions were retrospectively reviewed and divided according to age into two groups: under 50 years (group 1) and over 50 years (group 2). The following information was collected: onset of lesion to admission; injury variables: aetiology, level, associated injuries, medical complications and surgical intervention; length of stay; American Spinal Injury Association (ASIA) impairment and motor scores; Barthel Index (BI) and Rivermead Mobility Index (RMI) to assess independence in daily living; Walking Index for Spinal Cord Injury to assess ambulation; patients destination at discharge. In a subset of 130 subjects, a block design, matching procedure was used to control for the covariant effects of injury characteristics, time from lesion and aetiology on age effects. Results: In the entire group of 284 patients, older subjects had a higher probability of having incomplete tetraplegia of nontraumatic origin; they also showed a shorter length of stay and a higher rate of complications. In the matched cohorts, younger patients showed better neurologic recovery (intended as ASIA impairment grade improvement and motor scores increase), significantly higher Barthel Index and RMI at discharge, a higher level of independence in spontaneous bladder and bowel management and a higher frequency of independent walking. Conclusion: Older individuals with spinal cord injury and disease do well, but have a less favourable outcome in regard to walking, bladder and bowel independence than younger subjects and have more associated medical problems. Different rehabilitative strategies, therefore, are required for older subjects, which maximises the shorter length of stay and provides the necessary medical care and increased physical assistant resources following discharge.

Walking index for spinal cord injury (WISCI): criterion validation

“…Walking function, however, is a very complicated activity, which may be affected by many factors. 12 Motor scores alone do not correlate completely with increased walking function, because other factors such as age, 4 pain, 30,31 balance, 32,33 spasticity, 34 overweight 35 and possibly duration of training may effect walking function. In fact in our patients, motor scores alone show a significant (r ¼ 0.57, Po0.001), but not complete correlation with the WISCI.…”

“…Walking function, however, is frequently impaired in both groups. 4 Recent epidemiological studies 5 demonstrated that a larger proportion of new traumatic cases presented as incomplete spinal cord lesions (eg some preservation of sensory and/or motor function below the lesion level) and therefore are more likely to regain walking function. Furthermore, advances in emergency medical care and the acute treatment of spinal cord lesions, for example, with methylprednisolone 6,7 suggests efficacy in reducing the severity of neurological impairment, which may also increase the proportion of incomplete lesions with resultant increased probability of recovery of walking function.…”

Traumatic and non-traumatic spinal cord lesions: an Italian comparison of neurological and functional outcomes

“…12 Neurological recovery was defined on the basis of improvement of motor scores and ASIA impairment grade. 2 Functional status at admission and discharge was assessed by:…”

“…Previously, several studies have been published examining the effect of various factors such as age, 2 neurological status at admission 3 and rehabilitation timing 4 on neurological and functional recovery after SCL. However, in spite of the high incidence of non-traumatic lesions, which is considered to vary between 25 and 80% of the total admission for spinal cord injuries, there are still few studies on the influence of different etiologies (namely traumatic vs non-traumatic) on SCL outcome; [5][6][7][8][9][10][11] this is probably due to the different features of the two populations with regard to age, lesion severity and lesion to admission time (LTA), which are wellknown prognostic factors: 5 therefore, the two groups of patients are poorly comparable.…”

Clinical canine spinal cord injury provides an opportunity to examine the issues in translating laboratory techniques into practical therapy

“…66,67 Thus, it is well recognised that there is substantial improvement in clinical signs in many human patients that suffer incomplete SCI, [68][69][70] which can, indeed, complicate analysis of clinical trials of novel therapeutic interventions. 71,72 However, in common with human SCI patients, there is a subpopulation of affected dogs in which recovery is incomplete or does not occur at all; these affected dogs can be identified with reasonable certainty at an early stage after injury because they lose all sensory and motor function in the hindquarters and pelvic limbs.…”