title: Physical impairment and walking function required for community ambulation in patients with cervical incomplete spinal cord injury.
abstract: METHODS
  Cross-sectional study.
  
  
  OBJECTIVE
  To identify the physical impairments and walking function required for community ambulation in patients with cervical incomplete spinal cord injury (ISCI).
  
  
  METHODS
  Chubu Rosai Hospital, Nagoya, Japan.
  
  
  METHODS
  Forty patients with cervical ISCI (mean age: 49.9 years, American Spinal Injury Association Impairment Scale D) were included. The primary outcome measure was community ambulation based on Spinal Cord Independence Measure outdoor scores for a distance of >480 m. We measured the upper- and lower-extremity motor scores (UEMS and LEMS), sensory and spasticity. The walking tests included 10 m of walking at a comfortable- and maximum-walking speed (CWS and MWS; m s(-1)), 6 min walking test (6 MWT; m) and the walking index for spinal cord injury II (WISCI II). Multivariate logistic regression models were used to assess the physical impairments associated with community ambulation. Receiver operating characteristic curves were analyzed to determine the cutoff points for physical impairment and walking function.
  
  
  RESULTS
  The LEMS (beta coefficient (β)=0.71) and UEMS (β=0.41) were independently associated with community ambulation in patients with cervical ISCI. The cutoff points of the LEMS, UEMS, CWS, MWS, 6MWT and WISCI II were 41.5, 36.5, 1.00 m s(-1), 1.32 m s(-1), 472.5 m and 17.5, respectively, which suggests moderate to high accuracy.
  
  
  CONCLUSIONS
  The LEMS and UEMS were the most important factors affecting community ambulation in patients with cervical ISCI. The cutoff points of the walking function tests were highly accurate; therefore, these points can serve as targets for walking training in the future.
authors.affiliation: 1] Department of Physical Therapy, Graduate School of Medicine, Nagoya University, Nagoya, Japan [2] Department of Rehabilitation Medicine, Chubu Rosai Hospital, Nagoya, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Hasegawa
authors.affiliation: Department of Physical Therapy, Graduate School of Medicine, Nagoya University, Nagoya, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Uchiyama
authors.affiliation: 1] Department of Physical Therapy, Graduate School of Medicine, Nagoya University, Nagoya, Japan [2] Research Fellowship division, Japan Society for the Promotion of Science, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Uemura
authors.affiliation: Department of Rehabilitation Medicine, Chubu Rosai Hospital, Nagoya, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Harada
authors.affiliation: Department of Rehabilitation Medicine, Chubu Rosai Hospital, Nagoya, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Sugiyama
authors.affiliation: Department of Rehabilitation Medicine, Chubu Rosai Hospital, Nagoya, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D020233:Gait Disorders, Neurologic / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D017063:Outcome Assessment, Health Care; D011596:Psychomotor Disorders / Q000175:diagnosis / Q000209:etiology*; D012372:ROC Curve; D012111:Residence Characteristics / Q000706:statistics & numerical data; D013119:Spinal Cord Injuries / Q000150:complications*; D016138:Walking / Q000502:physiology*