Establishing prognosis and maximizing functional outcomes after spinal cord injury: a review of current and future directions in rehabilitation management.
METHODS
Review article.


OBJECTIVE
To review the medical literature and provide a framework for predicting neurorecovery and functional outcomes after spinal cord injury based on injury severity.


BACKGROUND
The ability to accurately predict the magnitude of neurorecovery and expected functional outcomes after spinal cord injury is of great importance. This information is needed to justify medical and rehabilitation interventions to third party payers as well as to begin the process of planning for postdischarge care. Over the past several decades, significant progress has been made in accurately predicting neurorecovery and its impact on functional outcomes.


METHODS
Structured review of published reports obtained through MED-LINE search and texts.


CONCLUSIONS
Within 72 hours to 1 month after a spinal cord injury, it is possible to predict with reasonable accuracy the magnitude of expected recovery based on physical examination. The impact of motor level on long-term functional outcomes is also clear and has remained relatively unchanged for several decades. Functional outcomes are likely to improve in upcoming years as novel interventions, such as drugs and functional neuromuscular stimulation, are developed with the goals of limiting secondary injury and restoring neurologic function. New training methods, such as body weight support, that use activity-dependent neuroplasticity will also have a more prominent role.
Burns
A S
AS
Department of Rehabilitation Medicine, Thomas Jefferson University, 132 South 10th Street, 375 Main Building, Philadelphia, PA 19107, USA. anthony.burns@mail.tju.edu
Ditunno
J F
JF
D006801:Humans; D015601:Injury Severity Score; D011237:Predictive Value of Tests; D011379:Prognosis; D020127:Recovery of Function; D013119:Spinal Cord Injuries / Q000503:physiopathology* / Q000534:rehabilitation*; D013997:Time Factors