title: Upper- and lower-extremity motor recovery after traumatic cervical spinal cord injury: an update from the national spinal cord injury database.
abstract: OBJECTIVE
  To present upper- (UEMS) and lower-extremity motor score (LEMS) recovery, American Spinal Injury Association Impairment Scale (AIS) change, and motor level change in persons with traumatic tetraplegia from the Spinal Cord Injury Model Systems (SCIMS).
  
  
  METHODS
  Longitudinal cohort; follow-up to 1 year.
  
  
  METHODS
  U.S. SCIMS.
  
  
  METHODS
  Subjects (N=1436; age>15y) with tetraplegia with at least 2 examinations, the first within 7 days of injury. Subjects were 80% men injured by vehicular collisions (44%), falls (30%), sports (12%), and violence (11%).
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Change in AIS, UEMS, LEMS, and motor levels.
  
  
  RESULTS
  From a baseline of 7 days or less, 22% of subjects with AIS grade A converted to AIS grade B or better by rehabilitation discharge; and 30%, by 1 year, with 8% to AIS grade C and 7.1% to grade D. Conversion from complete to motor incomplete was not related to timing of the initial examination (P=.54) or initial neurologic level (P=.96). For AIS grade B, 34% remained motor complete, 30% became AIS grade C, and 37% became grade D by 1 year. Although 82.5% of those with AIS grade C improved to AIS grades D and E, mean 1-year UEMS score was only 35 points. UEMS scores in patients with AIS grade A increased a mean of 9 to 11 points, except for C1 to C3 and C8 to T1 motor levels (gain, 2-3 points). Motor level was unchanged or ascended in 35% and improved 1 level in 42%, 2 levels in 14%, and more than 2 levels in 9%. Motor zone of partial preservation of 2 segments or more was associated with gain of 2 or more motor levels, with a relative risk of 5.0 (95% confidence interval, 3.2-7.8; P<.001).
  
  
  CONCLUSIONS
  More patients with cervical complete spinal cord injury may be converting to AIS grade D compared with earlier reports. Motor level recovery in those with AIS grade A and UEMS recovery in those with AIS grade C injuries are potential outcomes for acute clinical trials.
authors.affiliation: Department of Rehabilitation Medicine, Thomas Jefferson University, Philadelphia, PA, USA. ralph.marino@jefferson.edu
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Marino
authors.forename: Stephen
authors.initials: S
authors.lastname: Burns
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Graves
authors.forename: Benjamin E
authors.initials: BE
authors.lastname: Leiby
authors.forename: Steven
authors.initials: S
authors.lastname: Kirshblum
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Lammertse
mesh_terms: D000293:Adolescent; D000328:Adult; D002574:Cervical Vertebrae; D002648:Child; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D011782:Quadriplegia / Q000209:etiology; D020127:Recovery of Function; D012959:Socioeconomic Factors; D013119:Spinal Cord Injuries / Q000150:complications / Q000534:rehabilitation*; D034941:Upper Extremity; D055815:Young Adult