Walking Outcome After Traumatic Paraplegic Spinal Cord Injury: The Function of Which Myotomes Makes a Difference?

Neurorehabilitation and Neural Repair, 2023 · DOI: 10.1177/15459683231166937 · Published: May 1, 2023

Spinal Cord Injury Neurology Rehabilitation

Simple Explanation

This study aims to predict walking ability in individuals with paraplegic spinal cord injury (SCI) by identifying the most relevant muscle functions. The study uses a stratification model to divide patients into subgroups based on their characteristics soon after the injury. The primary outcome was the 6-minute walk test at 6 months after injury. Neurological assessments done within 15 days after injury were used as predictors to determine the probability of walking. The study found that proximal myotomes (L2 and L3) were key for differentiating between walkers and non-walkers, while distal myotomes (L4-S1) were important for distinguishing between indoor and outdoor walkers.

Study Duration

August 2001 and July 2019

Participants

361 individuals with paraplegic SCI

Evidence Level

Not specified

Key Findings

1
Proximal myotomes L2 and L3 were driving factors for the differentiation between walkers and non-walkers.
2
Distal myotomes L4–S1 were revealed to be responsible for the prognostic distinction of indoor and outdoor walkers (with and without aids).
3
85% of patients with a motor score in the L2 myotome of 1 or higher achieved ambulatory capacity throughout rehabilitation.

Research Summary

The study stratifies individuals with paraplegic SCI into more homogeneous subgroups using URP–CTREE. Proximal myotomes (L2 and L3) are key determinants for ambulation, differentiating walkers from non-walkers. Residual muscle function in distal myotomes L4–S1 is crucial to become an outdoor walker 6 months after injury. The study introduces a method for stratification potentially applicable to other neurological disorders with heterogeneous clinical manifestations.

Practical Implications

Clinical Trials

The URP–CTREE method can be used to tailor treatments to the needs of specific subgroups of patients with paraplegic SCI and to select appropriate study participants.

Rehabilitation Planning

The identified subgroups and key myotomes can provide additional useful information on expected rehabilitation outcomes to patients and health professionals, aiding in planning rehabilitation strategies.

Prognosis Improvement

Future studies should focus on improving stratification and prediction of SCI patients by exploring current assessments and implementing new ones.

Study Limitations

1
Data completeness may have introduced bias, as data availability varies with the severity of injury.
2
The simplicity of the measures may result in missing out on information, which could be captured by more complex assessments.
3
The EMSCI study protocol does not cover all variables influencing predictors and outcomes, potentially interfering with the accuracy of the stratification model.

Your Feedback

Was this summary helpful?

Back to Spinal Cord Injury