A Single Dermatome Clinical Prediction Rule for Independent Walking 1 Year After Spinal Cord Injury

Arch Phys Med Rehabil, 2024 · DOI: 10.1016/j.apmr.2023.06.015 · Published: January 1, 2024

Spinal Cord Injury Rehabilitation Research Methodology & Design

Simple Explanation

This study aimed to create a simple tool to predict if someone with a spinal cord injury (SCI) will be able to walk independently one year after their injury. The tool focuses on testing pinprick sensation at the lateral heels (S1 dermatome) and doesn't rely on complicated motor function tests. The study found that pinprick sensation in the lateral heels is a good predictor of walking ability, even for those with moderate SCI severity.

Study Duration

Not specified

Participants

3679 individuals with traumatic SCI

Evidence Level

Not specified

Key Findings

1
Pinprick testing at S1 over lateral heels, within 31 days of SCI, accurately identified future independent walkers 1 year after SCI.
2
Normal pinprick in both lateral heels provided good prognosis, any pinprick sensation in either lateral heel provided fair prognosis, and no sensation provided poor prognosis.
3
The CPR may work best for ruling in future independent walkers when applied within 0-7 days of SCI, yet may work best for ruling out future independent walkers when applied later on.

Research Summary

The study derived and validated a clinical prediction rule (CPR) using pinprick sensory testing at the lateral heels (S1 dermatomes) to predict independent walking after SCI. The CPR demonstrated that normal pinprick sensation at both lateral heels indicates a good prognosis, any sensation a fair prognosis, and no sensation a poor prognosis for independent walking. The CPR is simple to implement, does not rely on motor scores, and provides predictive value for individuals across the SCI recovery spectrum, including those with AIS B and C injuries.

Practical Implications

Early Prognosis

Allows clinicians to provide early and accurate prognosis for independent walking after SCI using a simple bedside test.

Targeted Interventions

Enables tailored rehabilitation strategies based on the predicted walking ability, prioritizing wheelchair training or neuromodulation as needed.

Improved Patient Counseling

Facilitates more informed discussions with patients and families about realistic expectations and rehabilitation goals.

Study Limitations

1
The CPR is less accurate in the AIS B and C subgroup than established CPRs.
2
The use of self-reported outcome measures for walking may not reflect actual walking performance.
3
External validation of the CPR in other cohorts and/or outside the United States is needed.

Your Feedback

Was this summary helpful?

Back to Spinal Cord Injury