Relationship between motor recovery and independence after sensorimotor-complete cervical spinal cord injury.
BACKGROUND
For therapeutics directed to the injured spinal cord, a change in neurological impairment has been proposed as a relevant acute clinical study end point. However, changes in neurological function, even if statistically significant, may not be associated with a functional impact, such as a meaningful improvement in items within the self-care subscore of the Spinal Cord Independence Measure (SCIM).


OBJECTIVE
The authors examined the functional significance associated with spontaneously recovering upper-extremity motor function after sensorimotor-complete cervical spinal cord injury (SCI).


METHODS
Using the European Multi-center Study about Spinal Cord Injury (EMSCI) data set, a retrospective analysis was undertaken of individuals with cervical sensorimotor-complete SCI (initial motor level, C4-C7). Specifically, changes in upper-extremity motor score (UEMS), motor level, and SCIM (total and self-care subscore) were assessed between approximately 1 and 48 weeks after injury (n = 74).


RESULTS
The initial motor level did not significantly influence the total UEMS recovered or number of motor levels recovered. SCIM self-care subscore recovery was significantly greater for those individuals regaining 2 motor levels compared with those recovering only 1 or no motor levels. However, the recovery in the SCIM self-care subscore was not significantly different between individuals recovering only 1 motor level and those individuals who showed no motor-level improvement.


CONCLUSIONS
A 2 motor-level improvement indicates a clinically meaningful change and might be considered a primary outcome in acute and subacute interventional trials enrolling individuals with cervical sensorimotor-complete SCI.
International Collaboration On Repair Discoveries (ICORD), University of British Columbia, and Vancouver Coastal Health, Vancouver, BC, Canada.
John L K
JL
Kramer
Daniel P
DP
Lammertse
Martin
M
Schubert
Armin
A
Curt
John D
JD
Steeves
D000203:Activities of Daily Living; D000328:Adult; D002574:Cervical Vertebrae / Q000293:injuries; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D057187:Independent Living; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology*; D011446:Prospective Studies; D020127:Recovery of Function; D012648:Self Care; D012677:Sensation / Q000502:physiology; D013119:Spinal Cord Injuries / Q000534:rehabilitation*; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology