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A Journal on Physical Medicine and Rehabilitation after Pathological Events
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Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,063
Europa Medicophysica 2003 June;39(2):69-78
Relationship between neurological level and functional recovery in spinal cord injury patients after rehabilitation
Zampa A. 1, Zacquini S. 2, Rosin C. 1, Bizzarini E. 1, Magrin P. 3, Saccavini M. 1
1 Spinal Unit, Rehabilitation Medicine Department Physical Medicine and Rehabilitation Institute, Udine, Italy
2 Medical School of Physical Medicine and Rehabilitation University of Trieste, Trieste, Italy
3 Medical School of Sport Medicine University of Udine, Udine, Italy
Aim. During the acute phase of spinal cord lesions, clinical evolution is evaluated through procedures of the neurological type, whereas during rehabilitation measures finalised to define functional assessment become more important. The study analyses the relationship between neurological level and functional outcome in a population of spinal cord injury (SCI) patients in the post-acute phase at the completion of an overall rehabilitation programme.
Methods. The retrospective study was conducted at the Spinal Unit of the Physical Medicine and Rehabilitation Hospital, Udine, Italy, on a population of 71 patients with traumatic and non-traumatic spinal cord lesions, all in the post-acute phase, with entrance neurological lesions corresponding to grade A, B or C of the American Spinal Injury Association ASIA impairment scale. The spinal cord injury patients were evaluated on discharge for completion of spinal cord damage (A, B, C, D) and subdivided by neurological level into 5 groups (C4, C5, C6-C7, D1-D6, D7-L1).
Results. Motor Functional Independence Measure (FIM) scores at discharge showed a progressive and constant increase as the neurological level descended in the caudal sense. Gains in motor FIM score between entrance and discharge were found to be significant on comparing groups of patients belonging to different neurological levels. A significant difference in score of the individual items in the motor FIM scale between adjacent neurological groups was only found in some cases.
Conclusion. The study shows an inverse relationship between scores obtained with the motor FIM and neurological level, such that high functional scores corresponded to a condition of less neurological damage. The FIM scale successfully discriminated for most items between tetraplegia and paraplegia but, without a from cervical to lumbar SCI patients continuum. Lastly, in our opinion in the evaluation of items relating of mobility and locomotion contextual, environmental and personal factors should also be analysed, as proposed recently in the International Classification of Functioning, Disability and Health (ICF).