Muscle force and gait performance: relationships after spinal cord injury.
OBJECTIVE
To relate locomotor function improvement, within the first 6 months after spinal cord injury (SCI), to an increase in Lower Extremity Motor Score (LEMS) and to assess the extent to which the level of lesion influenced the outcome of ambulatory capacity.


METHODS
Longitudinal and cross-sectional analyses.


METHODS
Seven SCI rehabilitation centers.


METHODS
Patients (N=178) were analyzed longitudinally (group A, motor complete; group B, motor incomplete; nonwalking or group C, motor incomplete and able to stand). The cross-sectional analysis included 86 patients (paraplegic, n=46; tetraplegic, n=40; group 1 with limited and group 2 with unrestricted walking function 6 mo after SCI).


METHODS
Not applicable.


METHODS
Walking Index for Spinal Cord Injury (WISCI), gait speed, and LEMS.


RESULTS
For group A, 24.8% of the patients improved in LEMS (median range, 0-10) and 7.7% in walking function (WISCI median range, 0-8; mean gait speed range, 0 to .14+/-.10 m/s). For group B, LEMS improved in 93.5% of the patients (median range, 14-28) and walking function in 84.8% of the patients (WISCI median range, 0-10; mean gait speed range, 0 to .41+/-.45 m/s) (P<.001). For group C, LEMS and walking function improved in 100% of the patients (LEMS median range, 29-41; WISCI median range, 8-16; mean gait speed range, .36+/-.29 m/s to .88+/-.44 m/s) (P=.001). In groups B and C, the improvement of walking function was greater than in LEMS. The cross-sectional analysis showed that group 1 patients with tetraplegia had more muscle strength (median LEMS, 31.5), and equal walking function (WISCI, 8; walking speed, 0.4+/-0.3 m/s) compared with patients with paraplegia (LEMS, 23; P<.01; WISCI, 12; P=0.6; speed, 0.4+/-0.3 m/s; P=.68). In group 2, patients with tetraplegia had slightly more strength (LEMS, 48) and equal walking function (WISCI, 20; walking speed, 1.4+/-0.3 m/s) compared with patients with paraplegia (LEMS, 45; P<.05; WISCI, 20; P=1.0; speed, 1.4+/-0.3 m/s; P=.89).


CONCLUSIONS
An improvement in locomotor function does not always reflect an increase in LEMS, and LEMS improvement is not necessarily associated with improved locomotor function. LEMS and ambulatory capacity are differently associated in patients with tetra- and paraplegia. Functional tests seem to complement clinical assessment.
Wirz
Markus
M
Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland. mwirz@paralab.balgrist.ch
van Hedel
Hubertus J
HJ
Rupp
Ruediger
R
Curt
Armin
A
Dietz
Volker
V
D000328:Adult; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D005684:Gait; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D010264:Paraplegia / Q000503:physiopathology*; D011782:Quadriplegia / Q000503:physiopathology*; D012047:Rehabilitation Centers; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000145:classification / Q000503:physiopathology* / Q000534:rehabilitation