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Published on: January 16, 2019
Physical Function Recovery Trajectories After Spinal Cord Injury
David S Tulsky1, Aaron J Boulton2, Pamela A Kisala2
1The Center for Health Assessment Research and Translation, University of Delaware, Newark, Delaware; Department of Physical Therapy, University of Delaware, Newark, Delaware; Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware.
Most spinal cord injury (SCI) patients show gradual functional recovery, with some experiencing significant improvements, especially in the first six months post-injury. Recovery trajectories vary, with some individuals showing more pronounced gains than others.
Area of Science:
- Rehabilitation medicine
- Neurology
- Clinical outcomes research
Background:
- Spinal cord injury (SCI) significantly impacts functional abilities.
- Understanding functional recovery trajectories is crucial for patient care and rehabilitation strategies.
Purpose of the Study:
- To identify and characterize distinct patterns of functional recovery in adults during the first two years after SCI.
- To explore factors influencing these recovery trajectories.
Main Methods:
- An observational cohort study involving 479 adults with SCI across eight SCI Model System sites.
- Longitudinal assessment using the Spinal Cord Injury-Functional Index (SCI-FI) item banks at multiple time points up to 24 months post-injury.
- Growth mixture modeling to identify distinct recovery trajectory groups.
Main Results:
- Two main recovery trajectories were identified for basic mobility and wheelchair mobility, with most individuals showing gradual improvement, especially within the first six months.
- A smaller subgroup demonstrated greater initial limitations but still achieved gradual functional gains.
- The self-care domain showed similar patterns, with a distinct subgroup exhibiting substantial early improvement.
- Fine motor function in individuals with tetraplegia revealed two patterns: modest or significant improvement from low initial scores.
- Injury and demographic factors predicted initial functional levels but had less influence on the rate of recovery.
Conclusions:
- Functional recovery after SCI follows a limited number of distinct patterns, with variations observed among individuals.
- While overall recovery is modest, significant improvements occur in specific domains for a subset of patients, particularly in fine motor and self-care functions.
- Further research is needed to elucidate the personal, medical, and environmental factors that shape these functional recovery trajectories post-SCI.
