TY - JOUR
T1 - Evaluation of Functional Independence in Cervical Spinal Cord Injury
T2 - Implications for Surgery to Restore Upper Limb Function
AU - Department of Defense (DOD) Group, European Multicenter Study of Spinal Cord Injury (EMSCI) Group
AU - Dengler, Jana
AU - Mehra, Munish
AU - Steeves, John D.
AU - Curt, Armin
AU - Maier, Doris
AU - Abel, Rainer
AU - Weidner, Norbert
AU - Rupp, Rüdiger
AU - Vidal, J.
AU - Benito, Jesus
AU - Kalke, Yorck Bernhard
AU - Curtin, Catherine
AU - Kennedy, Carie
AU - Miller, Amanda
AU - Novak, Christine
AU - Ota, Doug
AU - Stenson, Katherine C.
AU - Fox, Ida K.
N1 - Funding Information:
IKF grant funding support was provided by the U.S. Department of Defense —Project #W81XWH-17-1-0285 “Supporting Patient Decisions about Upper-Extremity Surgery in Cervical SCI.”
Funding Information:
The members of the Department of Defense (DOD) group are Catherine Curtin, MD, Palo Alto Veterans Healthcare System, Palo Alto, CA; Carie Kennedy, BSN, RN, Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO; Amanda Miller, MD, Division of Physical Medicine and Rehabilitation, Washington University School of Medicine, St. Louis, MO; Christine Novak, PhD, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Doug Ota, MD, Palo Alto Veterans Healthcare System, Palo Alto, CA; and Katherine C. Stenson, MD, Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, and VA St. Louis Healthcare System, St. Louis, MO. The members of the EMSCI group are Armin Curt, MD, Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland; Doris Maier, MD, BG-Trauma Center, Murnau, Germany; Rainer Abel, MD, PhD, Hohe Warte Bayreuth, Bayreuth, Germany; Norbert Weidner, MD, PhD, Rüdiger Rupp, MD, Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany; J. Vidal, MD, Institute Guttmann, Neurorehabilitation Hospital, Barcelona, Spain; Jesus Benito, MD, Institute Guttmann, Neurorehabilitation Hospital, Barcelona, Spain; and Yorck-Bernhard Kalke, MD, RKU Universitäts- und Rehabilitationskliniken Ulm, Ulm, Germany. IKF grant funding support was provided by the U.S. Department of Defense—Project #W81XWH-17-1-0285 “Supporting Patient Decisions about Upper-Extremity Surgery in Cervical SCI.”, The contents of this work do not represent the views of the U.S. Department of Veterans Affairs or the U.S. Government.
Publisher Copyright:
© 2021 American Society for Surgery of the Hand
PY - 2021/7
Y1 - 2021/7
N2 - Purpose: To help individuals make informed choices regarding the optimal type and timing of restorative surgical treatment for cervical spinal cord injury (SCI), more precise information is needed on their ability to perform activities of daily living. The goal of this work was to describe functional independence achieved by individuals with differing levels of cervical SCI. Methods: Using the comprehensive European Multicenter Study of Spinal Cord Injury dataset, analysis was undertaken of individuals with traumatic SCI, motor-level C5–C8. Data on feeding, bladder management, and transfers (bed to wheelchair) were compared between individuals with different levels of injury. Subgroup analyses of symmetrical and asymmetrical SCI and between complete and incomplete SCI were performed. The impact of age, sex, and time postinjury on functional independence was ascertained. Results: Data were available for individuals with symmetrical (n = 204) and asymmetrical (n = 95) patterns of SCI. Independence with feeding, urinary function, and transfer ability was increased in individuals with strong finger flexion. Unexpectedly, the presence of strong elbow extension did not uniformly result in the ability to transfer independently. There was no change in any of the analyzed activities between 6 and 12 months postinjury. Conclusions: People with cervical SCI who gain finger flexion have greater independence with feeding, urinary, and transfer activities. Restoration of finger flexion should be a reconstructive priority for individuals with midcervical-level SCI. Type of study/level of evidence: Prognostic IV.
AB - Purpose: To help individuals make informed choices regarding the optimal type and timing of restorative surgical treatment for cervical spinal cord injury (SCI), more precise information is needed on their ability to perform activities of daily living. The goal of this work was to describe functional independence achieved by individuals with differing levels of cervical SCI. Methods: Using the comprehensive European Multicenter Study of Spinal Cord Injury dataset, analysis was undertaken of individuals with traumatic SCI, motor-level C5–C8. Data on feeding, bladder management, and transfers (bed to wheelchair) were compared between individuals with different levels of injury. Subgroup analyses of symmetrical and asymmetrical SCI and between complete and incomplete SCI were performed. The impact of age, sex, and time postinjury on functional independence was ascertained. Results: Data were available for individuals with symmetrical (n = 204) and asymmetrical (n = 95) patterns of SCI. Independence with feeding, urinary function, and transfer ability was increased in individuals with strong finger flexion. Unexpectedly, the presence of strong elbow extension did not uniformly result in the ability to transfer independently. There was no change in any of the analyzed activities between 6 and 12 months postinjury. Conclusions: People with cervical SCI who gain finger flexion have greater independence with feeding, urinary, and transfer activities. Restoration of finger flexion should be a reconstructive priority for individuals with midcervical-level SCI. Type of study/level of evidence: Prognostic IV.
KW - Cervical-level spinal cord injury
KW - Spinal Cord Independence Measure (SCIM)
KW - nerve transfers
KW - tetraplegia
KW - upper extremity function
UR - http://www.scopus.com/inward/record.url?scp=85099485092&partnerID=8YFLogxK
U2 - 10.1016/j.jhsa.2020.10.036
DO - 10.1016/j.jhsa.2020.10.036
M3 - Article
C2 - 33454154
AN - SCOPUS:85099485092
SN - 0363-5023
VL - 46
SP - 621.e1-621.e17
JO - Journal of Hand Surgery
JF - Journal of Hand Surgery
IS - 7
ER -