Impairment Rating and Spinal Cord Injuries: Revisiting the Guides

2010 ◽  
Vol 15 (3) ◽  
pp. 1-7
Author(s):  
Richard T. Katz
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Functional Independence ◽  
Outcome Data ◽  
Multiple Organ ◽  
Loss Of Function ◽  
Sixth Edition ◽  
Organ Systems ◽  
Cord Injury ◽  
Impairment Ratings

Abstract This article addresses some criticisms of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) by comparing previously published outcome data from a group of complete spinal cord injury (SCI) persons with impairment ratings for a corresponding level of injury calculated using the AMA Guides, Sixth Edition. Results of the comparison show that impairment ratings using the sixth edition scale poorly with the level of impairments of activities of daily living (ADL) in SCI patients as assessed by the Functional Independence Measure (FIM) motor scale and the extended FIM motor scale. Because of the combinations of multiple impairments, the AMA Guides potentially overrates the impairment of paraplegics compared with that of quadriplegics. The use and applicability of the Combined Values formula should be further investigated, and complete loss of function of two upper extremities seems consistent with levels of quadriplegia using the SCI model. Some aspects of the AMA Guides contain inconsistencies. The concept of diminishing impairment values is not easily translated between specific losses of function per organ system and “overall” loss of ADLs involving multiple organ systems, and the notion of “catastrophic thresholds” involving multiple organ systems may support the understanding that variations in rating may exist in higher rating cases such as those that involve an SCI.

scholarly journals A complex case of neuro-muscular rehabilitation with favorable evolution, in a patient with incomplete tetraplegia post cervical and thoracic spinal cord injury - surgically treated, in a politraumatic context, by car accident

2020 ◽  
pp. 524-526
Author(s):  
Andreea DUMITRASCU ◽  
Ioana ANDONE ◽  
Aura SPÎNU ◽  
Carmen CHIPĂRUȘ ◽  
Cristina POPESCU ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Injuries ◽  
Functional Independence ◽  
Complex Case ◽  
Urinary Catheterization ◽  
Functional Evaluation ◽  
Thoracic Spinal Cord ◽  
Cord Injury ◽  
Car Accident

Introduction: Spinal cord injuries (SCI) are major conditions that usually determine severe and permanent dysfunctions, or even important loss of basic functions, generating severe or rather permanent sequels. They can have important chronic consequences such as: tetraplegia or paraplegia.(1). Materials and Methods: This paper presents the case of a young 19-year-old patient who suffered in March 2019, a car accident (passenger) with spinal cord injury (SCI) at cervical and thoracic level in a politraumatic context, hospitalized at the Neurosurgery Clinic (NS) II of TEHBA in a severe condition, for complete AIS/Frankel A tetraplegia, with a C7 fracture, T3, T4, T5 cominutive fractures with fragments in the medullary channel, minor traumatic brain injury, multiple costal fractures, abdominal trauma and respiratory failure. When the patient became hemodynamic and respiratory stable it was decided a neuro-surgical intervention, initially at cervical level through an anterior approach, with mixed osteo-sinthesis and C7 discectomy. Because of the spine instability, thoracic surgical treatment was delayed with 11 days, when he suffers a neurosurgery for medullary decompression, drainage and stabilization of the spine. In our clinical division, the patient was admitted with an incomplete AIS/Frankel B tetraplegia and initially followed a rehabilitation nursing program and subsequently continued with a recovery therapy according to clinical stages. The patient was assessed functionally using the following scales: AIS/Frankel, modified Ashworth, Functional Independence Measure (FIM), Life Quality Assessment (QOL), FAC International Scale, Independence Assessment Scale in Daily Activities (ADL / IADL), Walking Scale for Spinal Cord Injury (WISCI). Results: The patient benefited from a complex neuro-muscular rehabilitation program, having a favorable evolution, with an increase in the evaluated scales scores – passing from AIS/Frankel B classification to a severe AIS/Frankel C stage, and thus, at the moment he is performing walking on short distances, through parallel bars, with long left leg orthosis and support from another person. It was tried a sphincter re-education, but, after urologic examination, because of the important spasticity in the lower limbs and of the urinary catheterization discomfort, it was decided that for a while the patient to remain with fixed urinary catheterization. Conclusions: Even if there is still no cure for SCI sequels, the accurate clinical-functional evaluation, the neurosurgical prompt therapeutic approach, adding complex nursing measures, personalized rehabilitative and kinetotherapy programs, in a young patient with SCI by car accident, determined neuro-locomotor improvements with an increase in patient’s quality of life.(1),(2). Keywords: spinal cord injuries, tetraplegia, traumatism, rehabilitation,

scholarly journals Controversies in the Surgical Management of Spinal Cord Injuries

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Ahmed M. Raslan ◽  
Andrew N. Nemecek
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Surgical Management ◽  
Spinal Cord Injuries ◽  
Late Onset ◽  
Initial Step ◽  
Outcome Data ◽  
Cord Injury ◽  
The Usa

Traumatic spinal cord injury (SCI) affects over 200,000 people in the USA and is a major source of morbidity, mortality, and societal cost. Management of SCI includes several components. Acute management includes medical agents and surgical treatment that usually includes either all or a combination of reduction, decompression, and stabilization. Physical therapy and rehabilitation and late onset SCI problems also play a role. A review of the literature in regard to surgical management of SCI patients in the acute setting was undertaken. The controversy surrounding whether reduction is safe, or not, and whether prereduction magnetic resonance (MR) imaging to rule out traumatic disc herniation is essential is discussed. The controversial role of timing of surgical intervention and the choice of surgical approach in acute, incomplete, and acute traumatic SCI patients are reviewed. Surgical treatment is an essential tool in management of SCI patients and the controversy surrounding the timing of surgery remains unresolved. Presurgical reduction is considered safe and essential in the management of SCI with loss of alignment, at least as an initial step in the overall care of a SCI patient. Future prospective collection of outcome data that would suffice as evidence-based is recommended and necessary.

Physical Activity, Quality of Life, and Functional Autonomy of Adults With Spinal Cord Injuries

2013 ◽  
Vol 30 (4) ◽  
pp. 317-337 ◽  
Author(s):  
Camilla Yuri Kawanishi ◽  
Márcia Greguol
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Injuries ◽  
Functional Independence ◽  
Cord Injury ◽  
Functional Autonomy ◽  
Using Data

This study aimed to perform a systematic review of studies that address the influence of physical activity on the quality of life and functional independence of adult individuals with spinal cord injury. The review was performed using data obtained from the MEDLINE, CINAHL, SciELO, LILACS, SPORTDiscus, Web of Science, Academic Search Premier, and PEDro databases using the following keywords: quality of life; functional independence; autonomy; independence; physical activity; activities of daily living; physical exercise; tetraplegia; paraplegia; spinal cord injury; physical disabilities; and wheelchair. Eleven studies met the inclusion criteria. Although there was a lack of consensus among the selected studies, the majority of them presented a strong correlation between physical activity and variables of quality of life and/or functional independence. Thus, physical activity appears to have an important influence on social relationships, functional independence, psychological factors, and physical aspects, which can enhance quality of life and independence in the performance of daily activities.

Neuroprotection for Spinal Cord Injury

2017 ◽  
Author(s):  
Christopher S. Ahuja ◽  
Michael Fehlings
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Injuries ◽  
Current Evidence ◽  
Mechanical Trauma ◽  
Secondary Injury ◽  
Loss Of Function ◽  
Cord Injury ◽  
Death And Loss

Traumatic spinal cord injuries (SCI) often have a devastating impact on quality of life for patients and their families. Neuroprotection for spinal cord injury is aimed at improving functional outcomes by limiting secondary injury processes that occur within the first minutes, hours, and days following the primary injury. The primary mechanical trauma initiates a secondary injury cascade where ischemia, inflammatory cell infiltration, and cytotoxic changes in the microenvironment cause further cell death and loss of function. Time-sensitive neuroprotective measures targeting these secondary insults have emerged as key therapeutic strategies. This chapter summarizes current evidence-based neuroprotective treatments, such as blood pressure augmentation, early surgical decompression, and intravenous methylprednisolone, as well as important emerging interventions, including therapeutic hypothermia, sodium channel blockade using riluzole, and the anti-inflammatory actions of minocycline. The chapter concludes by summarizing the current guidelines that all practitioners should be well-versed in prior to providing care for patients with SCI.

scholarly journals Demographic characteristics and functional outcomes in patients with traumatic and nontraumatic spinal cord injuries

2012 ◽  
Vol 69 (12) ◽  
pp. 1061-1066 ◽  
Author(s):  
Sasa Milicevic ◽  
Zoran Bukumiric ◽  
Aleksandra Karadzov-Nikolic ◽  
Rade Babovic ◽  
Slobodan Jankovic
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Functional Outcomes ◽  
Spinal Cord Injuries ◽  
Case Series ◽  
Functional Independence ◽  
Demographic Characteristics ◽  
Case Series Study ◽  
Cord Injury ◽  
Detailed Medical History

Background/Aim. Spinal cord injuries (SCI) could be associated with a significant functional impairment in the areas of mobility, self-care, bowel and bladder emptying and sexuality. The aim of this study was to compare demographic characteristics and functional outcomes of nontraumatic and traumatic spinal cord injury patients. Methods. This study was designed as retrospective case series study. A detailed medical history including sex, age, mode of trauma, and clinical and radiological examination was taken for all patients. Hospital records were used to classify the patients according to the following: mechanism of injury, neurological level of injury, functional outcomes, associated injuries, method of treatment, secondary complications and length of stay. The following clinical scores were measured in the patients: American Spinal Injury Association standards (CASTA), Functional Independence Measure (FIM), and Modified Aschworth score (MAS). Results. Out of totally 441 patients with spinal cord injury, 279 were traumatic patients (TSCI) and 162 nontraumatic patients (NTSCI); 322 men and 119 women. The mean age of the patients was 46.1 ? 19.9 years. Traumatic and nontraumatic populations showed several significant differences with regard to age, level and severity of lesion. When adjusted for these factors patients with traumatic injuries showed a significantly lower FIM score at admission and significantly better improvement in the FIM score at discharge. The two populations were discharged with similar functional outcome. Conclusions. The NTSCI patients in our study were younger, more frequently female, with less complications before rehabilitation and less frequently treated operatively than the TSCI patients. Hospital rehabilitation of the TSCI patients was longer than that of the NTSCI patients, but their functional gain from admission was also higher, so at discharge. Traumatic and nontraumatic spinal cord lesion patients achieved similar results in regard to neurological and functional status.

Recreational therapy services with individuals recovering from spinal cord injury in inpatient rehabilitation: A cost-effectiveness analysis

2017 ◽  
Vol 13 (3) ◽  
pp. 13
Author(s):  
Brent L. Hawkins, PhD, LRT/CTRS ◽  
Richard S. Williams, EdD, LRT, CTRS ◽  
Kindal A. Shores, PhD ◽  
David P. Loy, PhD, LRT, CTRS ◽  
Craig E. Landry, PhD ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Ordinary Least Squares ◽  
Recreational Therapy ◽  
Rehabilitation Programs ◽  
Cord Injury ◽  
Therapeutic Services

The purpose of this study was to examine the cost of delivery of inpatient therapeutic services in relation to their influence on change in functional independence (as measured by the Functional Independence Measure [FIM]) of people with spinal cord injuries (SCIs). Participants included adults with SCI (N = 549) who received treatment during inpatient rehabilitation at the study site during a 7-year span. Results from ordinary least squares multiple regression analysis indicated that recreational therapy (RT) significantly predicted both total and motor FIM scores, while occupational therapy (OT) predicted motor FIM change. When costs of service provision and change in motor FIM scores were compared, RT required fewer units of treatment to predict change in motor FIM scores and was less costly per unit than OT. Although not causal, findings provide evidence of the benefits of RT and lend support to the continued use of RT in inpatient rehabilitation programs.

scholarly journals P.076 Epidemiology of traumatic spinal cord injury patients in New Brunswick

2016 ◽  
Vol 43 (S2) ◽  
pp. S38-S39
Author(s):  
YZ Chishti ◽  
D Gaudet ◽  
C O’Connell ◽  
N Attabib
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
New Brunswick ◽  
Motor Vehicle ◽  
Functional Independence ◽  
Outcome Data ◽  
Traumatic Spinal Cord Injury ◽  
Surgical Interventions ◽  
Cervical Spine Injuries ◽  
Cord Injury

Background: Characteristics of traumatic spinal cord injury (tSCI) patients admitted to the Saint John Regional Hospital and the Stan Cassidy Center for Rehabilitation from 2011 to 2014 were examined. Methods: Demographic, neurological and functional outcome data for 18 patients, who had consented to participate in a database for tSCI in Canada, was obtained. Results: The majority of patients were male (88.9%), with a mean age of 41. 33 (SD=17.17). The most common causes of tSCI were motor vehicle accidents (41.2%) and falls (29.4%). Cervical spine injuries (70.6%) and an ASIA impairment scale classification of D (38.9%) predominated. The median latency from injury to surgery was 22.67 hours. Functional independence Measure scores (M=64.17, SD=25.84) indicated that motor/functional independence was impaired (M=32.44, SD=19.15) relative to cognitive independence (M=31.83, SD=4.07). Conclusions: The results suggest that characteristics of tSCI patients in New Brunswick are similar to the Canadian tSCI patient population. Emergency care appears to be delivered in a timely fashion. Both centers participate in research registries focused on collecting data related to tSCI, surgical interventions, and patient outcomes. Registries are valuable research tools that allow for an alternative way to examine the quality of care their patients receive.

scholarly journals Classifications Used in Spinal Cord Injuries

2021 ◽  
Author(s):  
Erek Öztürk ◽  
Yener Akyuva ◽  
Erdinç Çivelek
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Injuries ◽  
Spinal Injury ◽  
Functional Independence ◽  
International Standards ◽  
Data Set ◽  
Multidimensional Pain Inventory ◽  
Cord Injury

Creating a common language allows information to be shared well/wholesome/healthily. Classifications have a important role in the formation of this language, which provides many benefits such as follow-up of the clinical course. Classifications in spinal cord injuries are based on examination, so the results of different treatments can be revealed more clearly with a standardized examination and registration. The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) which is the most sensitive and common classification was developed by the American Spinal Injury Association (ASIA) and the International Spinal Cord Society (ISCoS), although its foundations were laid in 1969 by Frankel. Apart from neurological evaluation, there are scales such as Functional Independence Scale, Modified Barthel Index, Spinal Cord Independence Scale, Quadriplegia Functional Index, Walking Index for Spinal Cord Injury, Spinal Cord Injury Functional Ambulation Inventory to determine the functional status in spinal cord injuries. Additionally scales such as Assessment of Spinal Cord Injury Basic Pain Data Set, Multidimensional Pain Inventory, DN4 (DouleurNeuropathique DN4) can be used for pain assessment in a patient with spinal cord injury.

scholarly journals POSTURAL CONTROL ASSESSMENT IN PHYSICALLY ACTIVE AND SEDENTARY INDIVIDUALS WITH PARAPLEGIA

2017 ◽  
Vol 25 (4) ◽  
pp. 147-150 ◽  
Author(s):  
Paola Errera Magnani ◽  
Alberto Cliquet Junior ◽  
Daniela Cristina Carvalho de Abreu
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Spinal Injury ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Trunk Control ◽  
Level Of Evidence ◽  
Physically Active ◽  
Cord Injury ◽  
Complete Spinal Cord Injury

ABSTRACT Objective: The aim of this study was to evaluate functional independence and trunk control during maximum-range tasks in individuals with spinal cord injuries, who were divided into sedentary (SSI, n=10) and physically active (PASI, n=10) groups . Methods: Anamnesis was conducted and level and type of injury were identified (according to the American Spinal Injury Association protocol, ASIA) and the Functional Independence Measure (FIM) questionnaire was applied. For the forward and lateral reach task, the subjects were instructed to reach as far as possible. Mean data were compared using the unpaired t test and Mann-Whitney test and differences were considered significant when p<0.05 . Results: The PASI group performed better in self-care activities (PASI: 40.8±0.42 points, SSI: 38.0±3.58 points, p=0.01), sphincter control (PASI: 10.5±1.84 points, SSI: 8.2±3.04 points, p=0.02), transfers (PASI: 20.7±0.48 points, SSI: 16.9±4.27 points, p=0.04), and total FIM score (PASI: 104.0±2.30 points, SSI 105.1±8.56 points, p=0.01). On the maximum reach task, the PASI group had a greater average range in all directions evaluated (p<0.05) . Conclusion: The continuous practice of exercise increased motor function independence and trunk control in individuals with complete spinal cord injury. Level of Evidence II, Prospective Comparative Study.

scholarly journals Epidemiology of Traumatic Spinal Cord Injury in the Netherlands: Emergency Medical Service, Hospital, and Functional Outcomes

2020 ◽  
Vol 26 (4) ◽  
pp. 243-252
Author(s):  
Menco J.S. Niemeyer ◽  
R.D. Lokerman ◽  
S. Sadiqi ◽  
M. van Heijl ◽  
R.M. Houwert ◽  
...  
Keyword(s):  
Spinal Cord ◽  
The Netherlands ◽  
Trauma Center ◽  
Spinal Cord Injuries ◽  
Functional Independence ◽  
Cervical Spine Injuries ◽  
Acute Surgery ◽  
Emergency Medical ◽  
Number Of Patients ◽  
Cord Injury

Background: Evaluating treatment of traumatic spinal cord injuries (TSCIs) from the prehospital phase until postrehabilitation is crucial to improve outcomes of future TSCI patients. Objective: To describe the flow of patients with TSCI through the prehospital, hospital, and rehabilitation settings and to relate treatment outcomes to emergency medical services (EMS) transport locations and surgery timing. Method: Consecutive TSCI admissions to a level I trauma center (L1TC) in the Netherlands between 2015 and 2018 were retrospectively identified. Corresponding EMS, hospital, and rehabilitation records were assessed. Results: A total of 151 patients were included. Their median age was 58 (IQR 37–72) years, with the majority being male (68%) and suffering from cervical spine injuries (75%). In total, 66.2% of the patients with TSCI symptoms were transported directly to an L1TC, and 30.5% were secondarily transferred in from a lower level trauma center. Most injuries were due to falls (63.0%) and traffic accidents (31.1%), mainly bicycle-related. Most patients showed stable vital signs in the ambulance and the emergency department. After hospital discharge, 71 (47.0%) patients were admitted to a rehabilitation hospital, and 34 (22.5%) patients went home. The 30-day mortality rate was 13%. Patients receiving acute surgery (&lt;12 hours) compared to subacute surgery (&gt;12h, &lt;2 weeks) showed no significance in functional independence scores after rehabilitation treatment. Conclusion: A surge in age and bicycle-injuries in TSCI patients was observed. A substantial number of patients with TSCI were undertriaged. Acute surgery (&lt;12 hours) showed comparable outcomes results in subacute surgery (&gt;12h, &lt;2 weeks) patients.

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