Outcome of the upper limb in cervical spinal cord injury: Profiles of recovery and insights for clinical studies

Abstract

Background

Improved appreciation of recovery profiles of sensory and motor function as well as complex motor functions (prehension) after cervical spinal cord injury (SCI) will be essential to inform clinical studies to consider primary and secondary outcome measures for interventions and the optimization of dosing and timing of therapies in acute and chronic SCI.

Objectives

(1) To define the sensory, motor, and prehension recovery profiles of the upper limb and hand in acute cervical SCI and (2) to confirm the impact of AIS severity and conversion on upper limb sensorimotor recovery.

Methods

An observational longitudinal cohort study consisting of serial testing of 53 patients with acute cervical SCI was conducted. International Standards of Neurological Classification of Spinal Cord Injury, Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP), Capabilities of Upper Extremity (CUE-Q) Questionnaire, and Spinal Cord Independence Measure III (SCIM-III) were administered at 0–10 days, 1, 3, 6, and 12 months.

Analysis

Change over time was plotted using mean and standard deviation of the total and subgroups of the sample.

Results

Individuals with traumatic tetraplegia show distinct patterns of recovery. Factors that distinguish homogeneous subgroups of the sample are: severity of injury (level of injury, completeness) at baseline and conversion from a complete to an incomplete injury.

Conclusions

In cervical SCI, clinical recovery can be assessed using standardized measures that distinguish levels of activity and impairment. Specific recovery profiles of the upper limb over the 1-year timecourse provide new insights and opportunity for combined analysis of recovery profiles for different clinical assessment tools of upper limb function which are meaningful to inform the design of study protocols.

Keywords:

• Upper limb
• Tetraplegia
• Recovery
• Outcome measure
• Sensorimotor function

Acknowledgments

The investigative team would like to acknowledge Dr Henry Ahn, Dr Christopher Bailey, Dr Brian Drew, Dr Dalton Wolfe, Heather Askes, Jean Brown, Kathy Butler, Naaz Desai, Deborah Tsui, Kayee Tung, Jennifer Urquhart, and Vera Zivanovic for their commitment to this study.