Influence of Age Alone, and Age Combined With Pinprick, on Recovery of Walking Function in Motor Complete, Sensory Incomplete Spinal Cord Injury

• Published in: Archives of physical medicine and rehabilitation Vol. 97; no. 10; pp. 1635 - 1641
• Main Authors: Oleson, Christina V., MD, Marino, Ralph J., MD, Leiby, Benjamin E., PhD, Ditunno, John F., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2016
• Subjects: Adult; Age Factors; Female; Humans; Lower Extremity; Male; Middle Aged; Neurologic Examination - methods; Physical Medicine and Rehabilitation; Prognosis; Recovery of Function; Rehabilitation; Rehabilitation Centers; Retrospective Studies; Spinal cord injuries; Spinal Cord Injuries - etiology; Spinal Cord Injuries - rehabilitation; Trauma Severity Indices; Walking; RR; spinal cord injury; NLI; AIS; neurologic level of injury; relative risk; SCIMS; American Spinal Injury Association Impairment Scale; ASIA; American Spinal Injury Association; SCI; Spinal cord injuries; Rehabilitation; Spinal Cord Injury Model System
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2016.01.024

Abstract Objective To determine if age, pinprick scores in the lower extremities, and neurologic severity of injury influence recovery of ambulation in persons with motor complete, sensory incomplete (American Spinal Injury Association Impairment Scale [AIS] grade B) spinal cord injury (SCI) 1 year after initial injury. Design This retrospective analysis examined subjects with AIS grade B from the Spinal Cord Injury Model System (SCIMS) database from 2006 to 2015. The baseline neurologic examination at rehabilitation admission (2–4wk postinjury) was used for comparison with 1-year outcome measures of locomotion. Setting Fifteen acute inpatient rehabilitation centers (participants in the SCIMS database). Participants Participants with AIS grade B SCI (N=249) were enrolled in the SCIMS database in 2 cycles (2006–2010 and 2011–2015). Interventions Not applicable. Main Outcome Measures Household ambulation at 1 year by FONE-FIM and by direct interview, as part of the annual neurologic exam; change in American Spinal Injury Association score 1 year postinjury. Results Findings demonstrate a statistically nonsignificant increase in likelihood of walking for those age <50 years compared with those age ≥50 years (relative risk [RR]=1.99; 95% confidence interval, 0.80–3.04). Presence of pinprick in at least one half of the lower-extremity dermatomes L2-S1 was associated with higher likelihood of walking (RR=5.57, P =.0023). Pinprick was significant for patients age <50 years (RR=4.58, P =.0090) but not for those age ≥50 years ( P =.15). Conclusions Compared with younger individuals, participants age ≥50 years with AIS grade B SCI are less likely to achieve walking function 1 year postinjury. Likewise, preservation of pinprick sensation postinjury in the majority of lower-extremity dermatomes L2-S1 increases the chances of walking in individuals age <50 years.