Superiority of motor level over single neurological level in categorizing tetraplegia

The purpose of this paper is to demonstrate the superiority of the American Spinal Injury Association motor level (ML) and upper extremity motor score (UEMS) to the neurological level (NL) in determining self care function in motor complete tetraplegia. Fifty subjects with traumatic motor complete tetraplegia, NL C4-C8, were evaluated at admission and 12 months post injury. At both time periods NL, ML, and UEMS were determined. At 12 months, reported ability to perform six feeding activities of the Quadriplegia Index of Function (QIF) were documented. Spearman correlations of the NL, BML, WML, UEMS, and feeding QIF scores were conducted, and results were compared with t tests for significant differences. Both the best and worst ML were more highly correlated to the UEMS than was the NL (0.96 and 0.96 vs 0.66, P < 0.001). The best and worst ML were more highly correlated to the QIF feeding score than was the NL (0.74 and 0.72 vs 0.56, P < 0.05). The UEMS had the highest correlation to the QIF feeding score, 0.78. These results suggest that the NL is an imprecise descriptor of the impairment in SCI, and is therefore a poor predictor of the resultant disability. The ML and the UEMS better reflect the severity of impairment and disability after motor complete tetraplegia.