title: Assessment of functional improvement without compensation reduces variability of outcome measures after human spinal cord injury.
abstract: OBJECTIVE
  To develop a scale (Neuromuscular Recovery Scale [NRS]) for classification of functional motor recovery after spinal cord injury (SCI) based on preinjury movement patterns that would reduce variability of the populations' level of function within each class, because assessment of functional improvement after SCI is problematic as a result of high variability of the populations' level of function and the insensitivity to change within the available outcome measures.
  
  
  METHODS
  Prospective observational cohort with longitudinal follow-up.
  
  
  METHODS
  Seven outpatient rehabilitation centers from the Christopher and Dana Reeve Foundation NeuroRecovery Network (NRN).
  
  
  METHODS
  Individuals (N=95) with American Spinal Injury Association Impairment Scale (AIS) grade C or AIS grade D having received at least 20 locomotor training treatment sessions in the NRN.
  
  
  METHODS
  Intensive locomotor training including stepping on a treadmill with partial body weight support and manual facilitation and translation of skills into home and community activities.
  
  
  METHODS
  Berg Balance Scale, six-minute walk test, and ten-meter walk test.
  
  
  RESULTS
  Individuals classified within each of the 4 phases of the NRS were functionally discrete, as shown by significant differences in the mean values of balance, gait speed, and walking endurance, and the variability of these measurements was significantly reduced by NRS classification. The magnitude of improvements in these outcomes was also significantly different among phase groups.
  
  
  CONCLUSIONS
  Assessment with the NRS provides a classification for functional motor recovery without compensation, which reduces variability in performance and improvements for individuals with injuries classified as AIS grades C and D.
authors.affiliation: Department of Physical Therapy, University of Florida, Gainesville, FL, USA. abehrman@phhp.ufl.edu
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Behrman
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ardolino
authors.forename: Leslie R
authors.initials: LR
authors.lastname: Vanhiel
authors.forename: Marcie
authors.initials: M
authors.lastname: Kern
authors.forename: Darryn
authors.initials: D
authors.lastname: Atkinson
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Lorenz
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Harkema
mesh_terms: D000328:Adult; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010045:Outpatients; D011446:Prospective Studies; D020127:Recovery of Function; D012047:Rehabilitation Centers; D013119:Spinal Cord Injuries / Q000534:rehabilitation*; D015599:Trauma Severity Indices; D016138:Walking