Article

OBJECTIVE: To present upper- (UEMS) and lower-extremity motor score (LEMS)
recovery, American Spinal Injury Association Impairment Scale (AIS) change, and
motor level change in persons with traumatic tetraplegia from the Spinal Cord
Injury Model Systems (SCIMS). DESIGN: Longitudinal cohort; follow-up to 1 year.
SETTING: U.S. SCIMS. PARTICIPANTS: Subjects (N=1436; age>15y) with tetraplegia
with at least 2 examinations, the first within 7 days of injury. Subjects were
80% men injured by vehicular collisions (44%), falls (30%), sports (12%), and
violence (11%). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Change in
AIS, UEMS, LEMS, and motor levels. RESULTS: From a baseline of 7 days or less,
22% of subjects with AIS grade A converted to AIS grade B or better by
rehabilitation discharge; and 30%, by 1 year, with 8% to AIS grade C and 7.1% to
grade D. Conversion from complete to motor incomplete was not related to timing
of the initial examination (P=.54) or initial neurologic level (P=.96). For AIS
grade B, 34% remained motor complete, 30% became AIS grade C, and 37% became
grade D by 1 year. Although 82.5% of those with AIS grade C improved to AIS
grades D and E, mean 1-year UEMS score was only 35 points. UEMS scores in
patients with AIS grade A increased a mean of 9 to 11 points, except for C1 to C3
and C8 to T1 motor levels (gain, 2-3 points). Motor level was unchanged or
ascended in 35% and improved 1 level in 42%, 2 levels in 14%, and more than 2
levels in 9%. Motor zone of partial preservation of 2 segments or more was
associated with gain of 2 or more motor levels, with a relative risk of 5.0 (95%
confidence interval, 3.2-7.8; P<.001). CONCLUSIONS: More patients with cervical
complete spinal cord injury may be converting to AIS grade D compared with
earlier reports. Motor level recovery in those with AIS grade A and UEMS recovery
in those with AIS grade C injuries are potential outcomes for acute clinical
trials.
CI - Copyright (c) 2011 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS