Presentation on theme: "Neurological Recovery After Traumatic SCI"— Presentation transcript:
1Neurological Recovery After Traumatic SCI Ralph J. Marino, MD, MSAssociate Professor, Rehabilitation MedicineThomas Jefferson UniversityPhiladelphia, PA, USANovember 24, 2007
2Regional Spinal Cord Injury Center of the Delaware Valley Affiliated institutions ofJefferson University HospitalMagee Rehabilitation Hospital
3ObjectivesDescribe recovery after SCI based on initial severity of injury.Compare and contrast upper extremity recovery after complete and incomplete cervical SCI.Identify factors predictive of ambulation after traumatic SCI.Highlight areas where further research is needed to predict recovery after SCI.
4International Standards for the Neurological Classification of Spinal Cord Injury
5Sensory Examination Test 28 dermatomes on each side of body. Light touch and pinprick.Three-point scale (0-2).Establish normal sensation on face or other non-involved area.Also test for deep anal sensation.
7Sensory LevelThe sensory level is the most caudal segment of the spinal cord with normal sensory function.Right and left sides are evaluated separately.Both pin prick and light touch sensation must be normal in this dermatome.
8Motor LevelThe motor level on each side is the most caudal segment of the spinal cord with normal motor function.Normal motor function refers to the myotome of the spinal cord, not to the key muscle being tested.
9The ASIA Impairment Scale A. Complete. No motor or sensory function in sacral segments S4-S5.B. Motor complete, sensory incomplete. Sensory sparing but no motor function below the zone of injury. Includes the sacral segments S4-5.C. Motor incomplete. Motor function preserved below the injury and less than half of key muscles have a muscle grade > 3.D. Motor incomplete. Motor function preserved below the neurological level and at least half of key muscles have a muscle grade > 3.E. Normal. Motor and sensory function are normal.
10Timing of Baseline Exam “Short term motor recovery in the zone of injury of motor complete quadriplegia is better predicted by the 72-hr MMT than the 24-hr MMT”Brown et al. 1991
11Reliability of Early Designation of Complete (Burns et al; 2003) Retrospective study of SCI patients at RSCICDV (Jefferson)Factors affecting reliability:mechanical ventilationintoxication/sedationClosed head injuryCerebral palsypsychiatric illnesslanguagesevere pain
12Reliability of Early Designation of Complete (Burns et al; 2003) Initial exam within 48 hrsOverall, 6.2% (5/81) convert A to B within the first weekBy one year, If NO factor, 1/38 (2.6%) convertto AIS BIf + factor, 4/43 (9.3%) convertto AIS B = 1, C = 2, D = 1
13Neurological Recovery After SCI: Model Systems (Marino et al., 1999) Subject selection:Admitted to System 1/1/88-12/31/97Within one week of traumatic SCI Exclude if:Minimal deficit on admissionDied within first yearIncomplete data
14Neurological Recovery After SCI: Model Systems Subjects: admitted| 391 died3974 alive at one year||----- , minimal deficit|------ 324, incomplete data3585 retained
15Neurological Recovery After SCI: Model Systems Ethnicity %Non-Hisp. WhiteAfrican American 28.9HispanicOtherSex %MaleFemaleEtiology %Vehicle crash 36.9Violence 29.3FallsSportsPedestrianMed/SurgOther