title: Late neurologic recovery after traumatic spinal cord injury.
abstract: OBJECTIVE
  To present Model Spinal Cord Injury System (MSCIS) data on late neurologic recovery after 1 year after spinal cord injury (SCI).
  
  
  METHODS
  Longitudinal study of neurologic status as determined by annual evaluations at 1 and 5 years postinjury.
  
  
  METHODS
  MSCIS centers contributing data on people with traumatic SCI to the National Spinal Cord Injury Statistical Center database.
  
  
  METHODS
  People with traumatic SCI (N=987) admitted to an MSCIS between 1988 and 1997 with 1- and 5-year follow-up examinations.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  American Spinal Injury Association (ASIA) Impairment Scale (AIS) classification, motor index scores (MIS), motor level, and neurologic level of injury (NLI), measured and compared for changes over time.
  
  
  RESULTS
  The majority of subjects (94.4%) who had a neurologically complete injury at 1 year remained complete at 5 years postinjury, with 3.5% improving to AIS grade B, and up to 1.05% each improving to AIS grades C and D. There was a statistically significant change noted for MIS. There were no significant changes for the motor level and NLI over 4 years; however, approximately 20% of subjects improved their motor level and NLI. People with complete and incomplete injuries had similar improvements in motor level, but subjects with an incomplete injury had a greater chance of improvement in NLI and MIS.
  
  
  CONCLUSIONS
  There was a small degree of neurologic recovery (between 1 and 5 y postinjury) after a traumatic SCI. Late conversion, between 1 and 5 years, from a neurologically complete to an incomplete injury occurred in 5.6% of cases, but in only up to 2.1% was there a conversion from motor complete to motor incomplete status. Limitations of this study included changes in the ASIA classification during the study and in the intra- and interrater reliability typically seen in longitudinal studies of the ASIA standards. Functional changes were not studied. Knowledge of the degree of late recovery may help in analyzing newer interventions to enhance recovery.
authors.affiliation: Kessler Institute for Rehabilitation, West Orange, NJ 07052, USA. skirshblum@kessler-rehab.com
authors.forename: Steven
authors.initials: S
authors.lastname: Kirshblum
authors.forename: Scott
authors.initials: S
authors.lastname: Millis
authors.forename: William
authors.initials: W
authors.lastname: McKinley
authors.forename: David
authors.initials: D
authors.lastname: Tulsky
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000294:innervation / Q000503:physiopathology; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007866:Leg / Q000294:innervation / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009048:Motor Skills; D009460:Neurologic Examination; D015588:Observer Variation; D011379:Prognosis; D020127:Recovery of Function; D013119:Spinal Cord Injuries / Q000145:classification / Q000503:physiopathology / Q000534:rehabilitation*; D013997:Time Factors; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014481:United States