Rehabilitation in spine and spinal cord trauma

Systematic review.

To define the optimal time for initiation of rehabilitation and review the most clinically relevant outcome measures of upper and lower limb motor function of the rehabilitating spinal cord injured patient, using a systematic review and expert opinion.

Comprehensive rehabilitation programs are required for patients after spinal cord injury (SCI) as early as feasible. In a dedicated SCI rehabilitation setting, effective treatment and proper monitoring of spontaneous and rehabilitation-based motor function improvements by means of appropriate, valid, reliable and internationally accepted clinical assessment tools is warranted.

Focused questions on key topics in rehabilitation of the spinal cord injured patient were defined by a panel of spine trauma surgeons. A keyword literature search for pertinent articles was conducted using multiple databases. Suitable articles were screened and the quality of evidence was graded and tabulated. Based on the evidence and expert opinion, recommendations were composed and rated as strong or weak.

The outcome measures literature search yielded a total of 1251 abstracts. Out of these 86 articles were studied in detail. One high quality study was found with 3 articles referring to it. Furthermore, there were 19 moderate quality studies, 39 low quality studies, and 25 very low quality studies. The timing literature search yielded 508 abstracts of which 3 articles focused on the question and were all graded as low quality.

For general motor function, assessing the American Spinal Injury Association motor score and the Spinal Cord Independence Measure III is strongly recommended. The American Spinal Injury Association motor score is also useful in assessing upper- and lower-extremity motor function. For ambulatory function, a timed walk test like the 10 m Walk test in combination with the Walking Index for SCI II is strongly recommended. Early rehabilitation, defined as within 30 days of injury, improves outcome and recovery for spinal cord trauma patients.