Spinal Cord Injury Medicine. 3. Rehabilitation Phase After Acute Spinal Cord Injury

Kirshblum, Steven; Priebe, Michael M.; Ho, Chester; Scelza, William M.; Chiodo, Anthony E.; Wuermser, Lisa Ann

doi:10.1016/j.apmr.2006.12.003

Cited by 124 publications

(87 citation statements)

References 32 publications

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“…[19][20][21] Currently applied criteria of complete Figure 2 Area under the receiver-operating characteristic (ROC) for the four acute phase sacral sparing item measurements for discriminating between the ability to walk independently or not (n ¼ 432). and incomplete SCI are based on the ASIA sacral sparing measurements.…”

Section: Discussionmentioning

confidence: 99%

“…18 With reference to the prediction of ambulatory recovery, a distinction between complete and incomplete SCI is commonly applied. [19][20][21] However, to date, the core elements of this distinction, the ASIA sacral sparing criteria, have not been validated with respect to chronic phase functional outcomes. It was our objective to validate the prognostic value of the acute phase sacral sparing measurements with regard to chronic phase-independent ambulation in SCI patients.…”

Section: Introductionmentioning

confidence: 99%

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Is determination between complete and incomplete traumatic spinal cord injury clinically relevant? Validation of the ASIA sacral sparing criteria in a prospective cohort of 432 patients

et al. 2009

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Study design: Prospective multicenter longitudinal cohort study. Objective: To validate the prognostic value of the acute phase sacral sparing measurements with regard to chronic phase-independent ambulation in patients with traumatic spinal cord injury (SCI). Results: To achieve independent ambulation 1-year post injury, a normal S4-5 PP score showed the best PPV (96.5%, Po0.001, 95% confidence interval (95% CI): 87.9-99.6). Best NPV was reported in the S4-5 LT score (91.7%, Po0.001, 95% CI: 81.6-97.2). The use of the combination of only voluntary anal contraction and the S4-5 LT and PP sensory scores (AUC: 0.906, Po0.001, 95% CI: 0.871-0.941) showed significantly better (Po0.001, 95% CI: 0.038-0.128) discriminating results in prognosticating 1-year independent ambulation than with the use of currently used distinction between complete and incomplete SCI (AUC: 0.823, Po0.001, 95% CI: 0.781-0.864). Conclusions: Out of the four sacral sparing criteria, the acute phase anal sensory score measurements do not contribute significantly to the prognosis of independent ambulation. The combination of the acute phase voluntary anal contraction and the S4-5 LT and PP scores, predicts significantly better chronic phase-independent ambulation outcomes than the currently used distinction between complete and incomplete SCI. Sponsorship: This study was granted by 'Acute Zorgregio Oost' and the 'Internationale Stiftung für Forschung in Paraplegie (IFP)'.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Is determination between complete and incomplete traumatic spinal cord injury clinically relevant? Validation of the ASIA sacral sparing criteria in a prospective cohort of 432 patients

et al. 2009

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“…However, because of the lack of modulation by disrupted descending pathways, many individuals demonstrate abnormal reflexes, which are often pharmacologically suppressed. 78 Numerous studies in both animals 79,80 and humans 81,82 have demonstrated that the spinal cord retains the ability to produce oscillating patterns of activity such as those required for gait. There is now a substantial literature demonstrating the role of activity-dependent plasticity leading to recovery of function after SCI.…”

Section: Exercise and Bonementioning

confidence: 99%

“…Given this activity at the level of basic science, it is incumbent on the rehabilitation community to reassess the goals of rehabilitation. Projected functional outcomes for motor complete SCI 12 months post-injury, as described by several studies 11,12 are currently used to guide rehabilitation goals. Although these are necessary for advising patients and their families, perhaps there needs to be a greater focus on the ongoing maintenance of optimum health and fitness, as well as maintenance of target systems below the level of injury (for example, muscle, bone, circulation) essential for improvement of health outcomes, and for future cures to be realized.…”

Section: Introductionmentioning

confidence: 99%

Spinal cord injury and physical activity: preservation of the body

Galea

2011

Spinal Cord

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Setting: Spinal cord injury (SCI) causes devastating loss of function and can result in serious secondary complications. Although significant advances are being made to develop cellular and molecular therapies to promote regeneration, it is important to optimize physical interventions. Objectives: The objective of this review was to examine the evidence for the effects of physical rehabilitation strategies on health and fitness, and maintenance of target systems below the level of injury (for example, muscle, bone, circulation).Results: Exercise appears to be a potent means of achieving these goals, using a variety of strategies. Conclusion: Physical rehabilitation after SCI needs to move beyond the goal of maximizing independence to focus on maintenance of optimum health and fitness as well as maintenance of target system function below the level of injury. Issues requiring further investigation include identification of the optimum dosage of interventions to achieve specific goals, for example, prevention of muscle atrophy and osteoporosis, and development and validation of simple clinical measures to monitor the changes in body composition. Adoption of a classification system for physical interventions and standardized outcome measures would facilitate large-scale observational studies to identify the critical variables contributing to better outcomes.

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“…It is also of utmost importance for caregivers as it could help them develop an appropriate rehabilitation plan and successful community reintegration [2].…”

Section: Introductionmentioning

confidence: 99%

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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Spinal Cord Injury Medicine. 3. Rehabilitation Phase After Acute Spinal Cord Injury

Cited by 124 publications

References 32 publications

Is determination between complete and incomplete traumatic spinal cord injury clinically relevant? Validation of the ASIA sacral sparing criteria in a prospective cohort of 432 patients

Is determination between complete and incomplete traumatic spinal cord injury clinically relevant? Validation of the ASIA sacral sparing criteria in a prospective cohort of 432 patients

Spinal cord injury and physical activity: preservation of the body

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

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