It is Never Too Late to Start: Functional Outcomes Following a Delayed Comprehensive Rehabilitation Program for Traumatic Spinal Cord Injury Patients (original) (raw)
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Khyber Medical University Journal
Mobility tasks such as bed mobility training (mat activities e.g. rolling, prone on elbow, prone on hands, supine on elbows, sitting in bed, vertical lift), transfers training (e.g. transfers to and from bed, oor, commode chair and car etc.) balance training, coordination training and gait training are applied in 10 order to achieve functional goals. These activities, not only enable SCI patients to live a dignied life but also h e l p i n p r e v e n t i n g s e c o n d a r y 11 complications associated with SCI. Although previous research studies reported signicant improvements in SCI patients who underwent standard rehabilitation program and mobility training, yet evidence regarding efcacy o f m o t o r t a s k s t r a i n i n g i s
Journal of Physical Medicine Rehabilitation Studies & Reports
Objective: To determine the outcomes of physical rehabilitation interventions at Paraplegic Center, Peshawar. Methods: This was Quasi experimental study, conducted from January 2018 to December 2019 at Paraplegic Center, Peshawar. A total of 306 persons with SCI were included in the study. Patients with ASIA-E level were excluded. Rehabilitation interventions including nursing care, physical and occupational therapy was applied for 4 days per week for a month. Spinal Cord Independence Measure (SCIM) scale was used for data collection. Data were analyzed using SPSS version 20 and T-test was used to compare the pre and post intervention’s scores, where p-value <0.05 was considered as significant.
Analysis of the Factors Influencing Functional Outcomes in Patients with Spinal Cord Injury
Journal of Physical Therapy Science, 2014
The extent of functional independence ultimately achieved by an individual patient will be influenced by a variety of medical and non-medical factors. [Subjects and Methods] this study included 419 patients with spinal cord lesions treated in the Clinic for Rehabilitation "Dr M. Zotovic", Belgrade, Serbia, from January 2000 to December 2009. The patients were divided in two groups according to achievement of increase in Functional Independence Measure (FIM) score of more than 13 at discharge compared to admission. A variety of clinical variables were followed in both groups. [Results] one hundred twenty-one patients (28.9%) showed improvements in FIM score of ≤13, while 298 (71.1%) patients showed an increases in FIM score of >13 at discharge compared to admission. Better functional recovery was observed in patients with non-traumatic spinal cord lesions, lower neurological levels of the lesion (OR = 6.07), and in patients treated surgically, but the level of the spinal cord lesion was the most influential factor affecting outcome. [Conclusion] the patients with spinal cord lesions should not only be grouped by traumatic and non-traumatic lesions only, but also subcategorized , according to the etiology, level of injury and treatment method.
Türkiye Fiziksel Tıp ve Rehabilitasyon Dergisi, 2017
Objectives: This study aims to analyze the demographic and clinical properties of patients with spinal cord injury (SCI) and to investigate the functional outcomes after rehabilitation. Patients and methods: In this retrospective and descriptive study, we investigated a total of 118 SCI patients (74 males, 44 females; mean age 41±16 years; range 13 to 74 years) with full records who were admitted to our rehabilitation program between January 2005 and December 2010. Demographic characteristics of the patients, etiological factors, time since injury, length of hospital stay, level of injury, as assessed by the American Spinal Injury Association (ASIA) Impairment Scale and functional status, as assessed by the Functional Independence Measure (FIM TM) on admission and discharge were analyzed. Complications related to SCI were also noted. Characteristic features of the patients', frequency of complications, and functional and neurological recovery were evaluated. Results: Of the patients, 70% were tetraplegic. The median time since injury was four months (IQR: 1 to 15 months), while the median length of stay was 76 days (IQR: 46 to 104 days). Four of 47 patients (8%) with Grade A (complete) according to the ASIA Impairment Scale on admission progressed to Grade B on discharge. Functional independence measure motor scores showed significant improvements at discharge (p<0.0001). The most common complications were urinary tract infections (70%), pressure ulcers (31%), and pain (28%). Conclusion: Inpatient rehabilitation in a tertiary referral hospital appears to provide substantial functional and motor gains in patients with SCI. Based on our study results, considerable improvement in the activities of daily living, as assessed by FIM motor scores, can be achieved with rehabilitation.
Spinal Cord, 2010
Study design: A prospective study. Objectives: To evaluate the changes of functional abilities, incidences of complications and falls of patients with spinal cord injury (SCI) 6 months after discharge. Setting: A major tertiary referral hospital, Thailand. Methods: Forty-four patients with SCI completed the study. Their average age and post-injury time were 45.23±13.78 years and 51.52±47.87 months respectively. Functional abilities of the subjects were measured by using the Spinal Cord Independence Measure II (SCIM II). Incidences of complications and falls were prospectively assessed every month by using a questionnaire. Results: After 6 months, the SCIM II scores of subjects showed a slight decrease (58.60 ± 21.22-58.37±22.06 scores). The significant decrement was illustrated in self-care and mobility scores of subjects with chronic motor incomplete SCI (Po0.05). Forty subjects experienced at least one medical complication (range 1-5 times) which 11 of them had to re-admit for 3-30 days. Twenty-four subjects sustained at least one fall in 6 months (range 1-24 times) which one subject had metatarsal bone fracture after fall. Conclusion: The functional ability of subjects with SCI, particularly those with chronic motor incomplete SCI, significantly decreased after discharge. The subjects also encountered a high risk of complications and falls that might associate with the decrement of functional ability. The findings confirmed important roles of community rehabilitation after discharge.
NeuroRehabilitation, 2014
To identify the possible factors influencing motor functional outcome of patients with traumatic spinal cord injury (T-SCI) after inpatient rehabilitation. 90 patients with T-SCI consecutively admitted for inpatient SCI rehabilitation unit was studied. Demographic characteristics, level and completeness of SC injury using American Spinal Injury Association (ASIA) Impairment Scale, disability level using Functional Independence Measure (FIM), psychological state using Hospital Anxiety and Depression Scale (HADS), and SCI-related medical complications were assessed and recorded at admission. The main measure of functional outcome was the motor FIM gain score at discharge. The univariate and multiple linear regression analyses were performed. The Mean admission motor FIM score was 35.3 (20.1), the mean discharge motor FIM score was 65.3 (22.5), and the mean motor FIM gain score was 30.0 (20.9). Univariate analyses indicated that the significant factors influencing motor functional outc...
Spinal Cord, 2015
Study design: Retrospective observational study. Objectives: The objective of this study was to determine the rehabilitation potential and the extent to which it is realized in a cohort of spinal cord injury patients using the Spinal Cord Injury-Ability Realization Measurement Index (SCI-ARMI) and to study the clinical factors that influence this realization. Setting: Two spinal units in Italy. Methods: Consecutive patients were assessed at the end of an in-patient rehabilitation program using the Spinal Cord Independence Measure and the International Standards for Neurological Classification of Spinal Cord Injury. On the basis of these data and of the age and gender of the patients, we calculated the SCI-ARMI score. Regression analyses were performed to study the relationship between clinical factors and the extent to which rehabilitation potential is realized. Results: We examined the data for 306 patients. Most patients were discharged without having reached their rehabilitation potential, with an SCI-ARMI score o80%. SCI-ARMI scores at discharge were positively influenced by etiology and the lesion level and correlated negatively with lesion severity and the presence of complications during rehabilitation. Conclusion: The SCI-ARMI is an effective tool that can be used to measure the achievement of rehabilitation potential in SCI patients and to identify groups of patients who are at risk of not meeting their rehabilitative potential.
Rehabilitation of Spinal Cord Injury: WFNS Spine Committee Recommendations
Neurospine, 2020
Spinal cord injury (SCI) is accompanied by a significant number of complications associated with damage to the spinal cord, gross functional impairments leading to limited self-care and movement, leading to a high level of disability, social and psychological maladaptation of the patients. Besides, pain and spasticity negatively affect rehabilitation programs. This search was conducted in PubMed/MEDLINE database. All studies published in English language (n = 16,297) were considered for inclusion. Of all studies evaluating rehabilitation in SCI patients (n = 80) were included. Based on the literature review the faculty of the WFNS Spine Committee created statements covering different aspects of the contemporary rehabilitation process of the SCI patients. The prepared statements were subjected to discussions, followed by anonymous voting process by the members of the WFNS Spine Committee. As result of the diccussions and the voting process the statements were modified and published as recommendations of the WFNS Spine Committee. The care for the SCI has gone a long way from the times after the World War II when these patients were considered hopeless in terms of any functional recovery, to the contemporary comprehensive rehabilitation programs. The rehabilitation is important part of the modern comprehencive treatment of SCI patients nowadays. The current manuscript reflects different aspects of the contemporary rehabilitaton process and decision makings, which were discussed by the faculty of the WFNS Spine Committee resulting in issuing of the following recommendations.
Objectives: The objective of this study was to conduct a systematic review of the literature to address the following clinical questions: In adult patients with acute and subacute complete or incomplete traumatic SCI, (1) does the time interval between injury and commencing rehabilitation affect outcome?; (2) what is the comparative effectiveness of different rehabilitation strategies , including different intensities and durations of treatment?; (3) are there patient or injury characteristics that affect the efficacy of rehabilitation?; and (4) what is the cost-effectiveness of various rehabilitation strategies? Methods: A systematic search was conducted for literature published through March 31, 2015 that evaluated rehabilitation strategies in adults with acute or subacute traumatic SCI at any level. Studies were critically appraised individually and the overall strength of evidence was evaluated using methods proposed by the GRADE (Grades of Recommendation Assessment, Development and Evaluation) working group. Results: The search strategy yielded 384 articles, 19 of which met our inclusion criteria. Based on our results, there was no difference between body weight–supported treadmill training and conventional rehabilitation with respect to improvements in Functional Independence Measure (FIM) Locomotor score, Lower Extremity Motor Scores, the distance walked in 6 minutes or gait velocity over 15.2 m. Functional electrical therapy resulted in slightly better FIM Motor, FIM Self-Care, and Spinal Cord Independence Measure Self-Care subscores compared with conventional occupational therapy. Comparisons using the Toronto Rehabilitation Institute Hand Function Test demonstrated no differences between groups in 7 of 9 domains. There were no clinically important differences in Maximal Lean Test, Maximal Sidewards Reach Test, T-shirt Test, or the Canadian Occupational Performance Measure between unsupported sitting training and standard in-patient rehabilitation. Conclusion: The current evidence base for rehabilitation following acute and subacute spinal cord injury is limited. Methodo-logical challenges have contributed to this and further research is still needed.