Degree of Contribution of Motor and Sensory Scores to Predict Gait Ability in Patients With Incomplete Spinal Cord Injury

Ann Rehabil Med, 2017 · DOI: https://doi.org/10.5535/arm.2017.41.6.969 · Published: December 1, 2017

Spinal Cord Injury Rehabilitation Biomechanics

Simple Explanation

This study aimed to prioritize the motor and sensory variables to expect the ability to walk in patients with incomplete SCI. We retrospectively reviewed the medical records of all patients with SCI admitted to the Department of Rehabilitation Medicine of CHA Bundang Medical Center between March 2014 and February 2015. Patients were allocated into ambulator and non-ambulator groups based on Spinal Cord Independence Measure (SCIM) item 12 measuring indoor mobility as scores between 0 to 8 with higher score indicating better ambulation capacity

Study Duration

Between 2 weeks and 2 years

Participants

30 patients with incomplete SCI

Evidence Level

Not specified

Key Findings

1
Motor and sensory scores were significantly different between the ambulators and non-ambulators. The majority was associated to the function of lower extremities.
2
Calculation of area under ROC curves (AUC) revealed that strength of hip flexor (L2) (AUC=0.905, p<0.001) and knee extensor (L3) (AUC=0.820, p=0.006) contributed the greatest to independent walking.
3
hip flexor strength (L2) was the single most powerful predictor of ambulation by the logistic regression analysis (odds ratio=6.3, p=0.049), and the model fit well to the data.

Research Summary

The most important potential contributor for independent walking in patients with incomplete SCI is the muscle strength of hip flexors, followed by knee extensors compared with other sensory and motor variables. ROC analysis revealed that the discriminating power of each motor and sensory score differed. The motor scores of hip flexor, followed by knee extensor showed remarkable accuracy. The strength of hip flexor and knee extensor may be the most important factors of SCI patients for independent gait. These findings may provide information for determination of rehabilitation goal setting regarding ambulation.

Practical Implications

Rehabilitation Goal Setting

Focus rehabilitation efforts on improving hip flexor and knee extensor strength in patients with incomplete SCI.

Prognostic Tool

Use hip flexor strength as a key predictor of ambulation potential in this patient population.

Compensatory Mechanisms

Recognize the role of hip flexors in compensating for distal muscle weakness during gait.

Study Limitations

1
The criteria for patient selection included a broad range of disease-affected period.
2
The etiology for spinal cord injury was not completely homogeneous and included trauma, tumor, inflammation, and spinal stenosis.
3
The dichotomous outcome from SCIM item 12 adopted in this study is limited as the assessment does not provide information of various aspects of locomotor ability.

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