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STUDY DESIGN: Retrospective statistical analysis of database. OBJECTIVES: Prediction of the Spinal Cord Independence Measure version III Total Score (SCIM-TS) at 6 months after injury based on physical findings at 1 month after injury is an important index for rehabilitation approach in the recovery phase. SETTING: Spinal Injuries Center, Fukuoka, Japan. METHODS: The study participants were selected from patients with traumatic spinal cord injuries who were registered in the Japan Single Center Study for Spinal Cord Injury Data Base (JSSCI-DB) of the Japan Spinal Injuries Center specializing in spine and spinal cord injuries. Of the 534 participants registered with the JSSCI-DB between January 2012 and October 2018, we retrospectively extracted 137 participants for 6 months after injury, and these participants were included in this study. RESULTS: According to multiple regression analysis, SCIM-TS at 6 months after injury could be predicted based on only six variables, i.e., age at injury, three key muscles (C6 wrist extensors, C8 finger flexors, and L3 knee extensors), and two mobility assessments (WISCI and SCIM-item13) (Adjusted R-Squared: 0.83). These six independent variables were significant factors reflecting SCIM-TS at 6 months. CONCLUSIONS: In rehabilitation after traumatic spinal cord injuries, a simple and reliable prognostic model can help accurately predict the achievable activity of daily living competency to set a goal. In addition, if the procedure is simple, evaluation can be completed in a short period of time, and the physical burden on both treating staff and patients can be reduced.
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Traumatismos da Medula Espinal , Atividades Cotidianas , Avaliação da Deficiência , Humanos , Japão , Prognóstico , Recuperação de Função Fisiológica , Estudos RetrospectivosRESUMO
Introduction: Recently, the cases of elderly individuals with spinal cord injuries are increasing in Japan. For individuals with spinal cord injury, regaining the ability to walk independently after an injury is one of the most important aspects of rehabilitation. Nevertheless, instead of age-optimized programs, uniform rehabilitation programs are currently provided to all patients because there is no information available for predicting prognosis based on age at the time of injury. This study aimed to elucidate the effect of age at the time of injury on the walking ability of patients with incomplete cervical spinal cord injury. Methods: Of the 1,195 patients registered in the Japan single-center study for spinal cord injury database, those hospitalized within 28 days after injury, followed up for >180 days, had a cervical spinal cord injury, and had a lower extremity motor score of ≥42 points were examined. Patients were stratified into three groups according to the age at the time of injury (≤59, 60-69, or ≥70 years). The walking ability scores and independence levels of mobility were compared; these data were evaluated based on indoor mobility (item 12) and outdoor mobility (item 14) in the Spinal Cord Independence Measure III and Walking Index for Spinal Cord Injury II. All comparisons used data at discharge. Results: The walking ability scores and independence levels of mobility were significantly lower in the group aged ≥70 years than those in the remaining two groups. Conclusions: In patients with cervical spinal cord injuries with the same limb function, if the age at the time of injury was ≥70 years, the decline in physical function due to aging exerted a substantial effect on walking ability.
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Objective: To analyze the impact of lower extremity deep sensory impairment on the walking capability of patients with incomplete cervical spinal cord injury.Design: Retrospective cohort study.Setting: Spinal Injuries Center, Fukuoka, Japan.Participants: Patients with incomplete cervical spinal cord injury who were transferred to the Spinal Injuries Center within 2 weeks of injury and whose progress was monitored for 6 months postinjury were included. Sixty-three patients with a lower extremity motor score of 42 points or more were enrolled. They were divided into lower extremity deep sensory impairment (16 patients) and normal (47 patients) groups, and their walking capability was compared.Interventions: Not applicable.Outcome Measures: Upper and lower extremity motor scores, the presence or absence of deep sensation impairment, and walking capability indices at 6 months postinjury were evaluated.Results: The deep sensory impairment group performed significantly worse than the normal group across items in the Walking Index for Spinal Cord Injury II and in the indoor and outdoor mobility items of the Spinal Cord Independence Measure III. Indoor and outdoor mobility independence levels decreased further in the lower extremity deep sensory impairment group than in the normal group.Conclusions: The presence of lower extremity deep sensation impairments was an important factor affecting the achievement of independent walking capabilities in patients with incomplete cervical spinal cord injury. Hence, when patients with incomplete cervical spinal cord injury undergo walking training, not only their lower extremity muscle strength but also their level of deep sensation impairment must be evaluated.
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Medula Cervical , Traumatismos da Medula Espinal , Humanos , Extremidade Inferior , Estudos Retrospectivos , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/reabilitação , Caminhada/fisiologiaRESUMO
OBJECTIVES: We evaluated the time course of the American Spinal Cord Injury Association (ASIA) impairment scale (AIS) for up to three months in participants within 72â h after traumatic spinal cord injury (TSCI) with complete paralysis. We aimed to determine the most useful sacral-sparing examination (deep anal pressure [DAP], voluntary anal contraction [VAC], S4-5 light touch [LT], or pin prick [PP] sensation) in determining AIS grades. DESIGN: Retrospective cohort study. SETTING: Spinal Injuries Center, Fukuoka, Japan. PARTICIPANTS: Among 668 TSCI participants registered in the Japan Single Center study for Spinal Cord Injury Database (JSSCI-DB) between January 2012 and May 2020, we extracted the data of 80 patients with AIS grade A within 72â h after injury and neurological level of injury (NLI) at T12 or higher. INTERVENTIONS: None. OUTCOME MEASURES: The sacral-sparing examination at the time of the change to incomplete paralysis was compared to the AIS determination using a standard algorithm and with each assessment including the VAC, DAP, S4-5LT, and S4-5PP examinations at the time of AIS functional change. Agreement among assessments was evaluated using weighted kappa coefficients. The relationship was evaluated using Spearman's rank correlation coefficients. RESULTS: Fifteen participants (18.8%) improved to incomplete paralysis (AIS B to D) within three months after injury. The single assessment among the sacral-sparing examinations with the highest agreement and strongest correlation with AIS determination was the S4-5LT examination (k = 0.89, P < 0.01, r = 0.84, P < 0.01). CONCLUSIONS: The S4-5LT examination is key in determining complete or incomplete paralysis due to its high discriminatory power.