title: Predictive Value of Upper Limb Muscles and Grasp Patterns on Functional Outcome in Cervical Spinal Cord Injury.
abstract: OBJECTIVE
  To determine which single or combined upper limb muscles as defined by the International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI); upper extremity motor score (UEMS) and the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP), best predict upper limb function and independence in activities of daily living (ADLs) and to assess the predictive value of qualitative grasp movements (QlG) on upper limb function in individuals with acute tetraplegia.
  
  
  METHODS
  As part of a Europe-wide, prospective, longitudinal, multicenter study ISNCSCI, GRASSP, and Spinal Cord Independence Measure (SCIM III) scores were recorded at 1 and 6 months after SCI. For prediction of upper limb function and ADLs, a logistic regression model and unbiased recursive partitioning conditional inference tree (URP-CTREE) were used. Results: Logistic regression and URP-CTREE revealed that a combination of ISNCSCI and GRASSP muscles (to a maximum of 4) demonstrated the best prediction (specificity and sensitivity ranged from 81.8% to 96.0%) of upper limb function and identified homogenous outcome cohorts at 6 months. The URP-CTREE model with the QlG predictors for upper limb function showed similar results.
  
  
  CONCLUSIONS
  Prediction of upper limb function can be achieved through a combination of defined, specific upper limb muscles assessed in the ISNCSCI and GRASSP. A combination of a limited number of proximal and distal muscles along with an assessment of grasping movements can be applied for clinical decision making for rehabilitation interventions and clinical trials.
authors.affiliation: Clinical Trial Unit, Swiss Paraplegic Center, Nottwil, Switzerland inge-marie.velstra@paraplegie.ch.
authors.forename: Inge-Marie
authors.initials: IM
authors.lastname: Velstra
authors.affiliation: Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland European Multicenter Study about Human Spinal Cord Injury (EMSCI), Zurich, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Bolliger
authors.affiliation: Clinical Trial Unit, Swiss Paraplegic Center, Nottwil, Switzerland.
authors.forename: Jörg
authors.initials: J
authors.lastname: Krebs
authors.affiliation: Roessingh Research and Development, Lab of Biomechanical Engineering, University of Twente, Enschede, Netherlands.
authors.forename: Johan S
authors.initials: JS
authors.lastname: Rietman
authors.affiliation: Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland European Multicenter Study about Human Spinal Cord Injury (EMSCI), Zurich, Switzerland.
authors.forename: Armin
authors.initials: A
authors.lastname: Curt
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D066193:Cervical Cord / Q000473:pathology*; D005060:Europe; D005080:Exercise Test / Q000379:methods / Q000592:standards*; D005260:Female; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011782:Quadriplegia / Q000175:diagnosis* / Q000209:etiology; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000150:complications / Q000175:diagnosis*; D034941:Upper Extremity / Q000503:physiopathology*; D055815:Young Adult
keywords: GRASSP; ISNCSCI; activities of daily living; prediction; spinal cord injury; tetraplegia; upper limb function