title: Relationship between neurological injury and patterns of upright mobility in children with spinal cord injury.
abstract: BACKGROUND
  The predictors and patterns of upright mobility in children with a spinal cord injury (SCI) are poorly understood.
  
  
  OBJECTIVE
  The objective of this study was to develop a classification system that measures children's ability to integrate ambulation into activities of daily living (ADLs) and to examine upright mobility patterns as a function of their score and classification on the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) exam.
  
  
  METHODS
  This is a cross-sectional, multicenter study that used a convenience sample of subjects who were participating in a larger study on the reliability of the ISNCSCI. A total of 183 patients between 5 and 21 years old were included in this study. Patients were asked if they had participated in upright mobility in the last month and, if so, in what environment and with what type of bracing. Patients were then categorized into 4 groups: primary ambulators (PrimA), unplanned ambulators (UnPA), planned ambulators (PlanA), and nonambulators.
  
  
  RESULTS
  Multivariate analyses found that only lower extremity strength predicted being a PrimA, whereas being an UnPA was predicted by both lower extremity strength and lack of preservation of S45 pinprick sensation. PlanA was only associated with upper extremity strength.
  
  
  CONCLUSIONS
  This study introduced a classification system based on the ability of children with SCI to integrate upright mobility into their ADLs. Similar to adults, lower extremity strength was a strong predictor of independent mobility (PrimA and UnPA). Lack of pinprick predicted unplanned ambulation, but not being a PrimA. Finally, upper extremity strength was a predictor for planned ambulation.
authors.affiliation: Shriners Hospitals for Children , Philadelphia, Pennsylvania.
authors.forename: Ross S
authors.initials: RS
authors.lastname: Chafetz
authors.forename: John P
authors.initials: JP
authors.lastname: Gaughan
authors.forename: Christina
authors.initials: C
authors.lastname: Calhoun
authors.forename: Jennifer
authors.initials: J
authors.lastname: Schottler
authors.forename: Lawrence C
authors.initials: LC
authors.lastname: Vogel
authors.forename: Randal
authors.initials: R
authors.lastname: Betz
authors.forename: M J
authors.initials: MJ
authors.lastname: Mulcahey
keywords: ISNCSCI; ambulation; pediatrics; spinal cord injury