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.
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.
Authors: Ralph J Marino; Rebecca Sinko; Anne Bryden; Deborah Backus; David Chen; Gregory A Nemunaitis; Benjamin E Leiby Journal: Top Spinal Cord Inj Rehabil Date: 2018
Authors: Bizhan Aarabi; Charles A Sansur; David M Ibrahimi; J Marc Simard; David S Hersh; Elizabeth Le; Cara Diaz; Jennifer Massetti; Noori Akhtar-Danesh Journal: Neurosurgery Date: 2017-04-01 Impact factor: 4.654
Authors: Ralph J Marino; Stephen B Kern; Benjamin Leiby; Mary Schmidt-Read; M J Mulcahey Journal: J Spinal Cord Med Date: 2014-10-09 Impact factor: 1.985
Authors: Robert G Grossman; Michael G Fehlings; Ralph F Frankowski; Keith D Burau; Diana S L Chow; Charles Tator; Angela Teng; Elizabeth G Toups; James S Harrop; Bizhan Aarabi; Christopher I Shaffrey; Michele M Johnson; Susan J Harkema; Maxwell Boakye; James D Guest; Jefferson R Wilson Journal: J Neurotrauma Date: 2013-10-11 Impact factor: 5.269
Authors: Elias B Thorp; Farnaz Abdollahi; David Chen; Ali Farshchiansadegh; Mei-Hua Lee; Jessica P Pedersen; Camilla Pierella; Elliot J Roth; Ismael Seanez Gonzalez; Ferdinando A Mussa-Ivaldi Journal: IEEE Trans Neural Syst Rehabil Eng Date: 2015-06-01 Impact factor: 3.802
Authors: Daniel C Lu; V Reggie Edgerton; Morteza Modaber; Nicholas AuYong; Erika Morikawa; Sharon Zdunowski; Melanie E Sarino; Majid Sarrafzadeh; Marc R Nuwer; Roland R Roy; Yury Gerasimenko Journal: Neurorehabil Neural Repair Date: 2016-05-18 Impact factor: 3.919