Abstract Details

Title Loss of Regained or Spared Function after SCI (Neuroworsening): Evidence and Dimension

Topic Neuro-rehabilitation

Presentation(s) P15 - Poster Session 15 (5:30 PM-6:30 PM)

Poster/Presentation
Number 7-001

Background

Information about risk factors and trajectories of neuroworsening after SCI is scarce. Acquired outcome modifying factors as well as detection of brain and spinal cord neurodegeneration, imply a more dynamic pathophysiology, even at chronic phases.

Objective To determine the occurrence of neuroworsening (loss of regained or spared function) by analyzing clinical indicators within 1-year after spinal cord injury (SCI) based on negative American Spinal Injury Association (ASIA) Impairment Scale (AIS) conversion rates (AIS_-?) in AIS B-D patients.

Design/Methods

We screened datasets of 16,214 patients enrolled in a prospective cohort study (National Spinal Cord Injury Database, Birmingham, AL, USA). AIS_-? were investigated and monitored up to 1-year after SCI. AIS_-? after rehabilitation discharge to 1-year were analyzed for their association with demographic factors and injury level/severity using logistic regression. The trajectories of secondary outcome measures, including ASIA Motor Scores and Functional Independence Measure (FIM) from injury to 1-year were analyzed using linear mixed models.

Results Within 3,299 patients meeting selection criteria, AIS_-? was most prominent from rehabilitation discharge to 1-year and AIS grade at discharge the sole predictor of neuroworsening at 1-year: AIS B_-? 13.5% (Odds Ratio [OR] 2.0), AIS C_-? 8.9 % (OR 1.3), AIS D_-? 2.9% (OR 1.0; reference). Adjusted mixed models revealed that AIS_-?during this interval are also associated with lower gains in upper (-4.5 points, 95% CI -5.4; -3.5) and lower extremity ASIA Motor Score (-13.6 points, 95% CI -14.8; -12.5), and FIM (-11.4 points, 95% CI -13.0; -9.7) observed after discharge but not during inpatient care and rehabilitation.

Conclusions Treatment results after SCI are not stable, challenging the prominent perception of reaching a uniform ‘recovery plateau’. About every 10^th patient is affected by delayed neuroworsening, exceeding occurrence of known factors, such as syringomyelia, and implies the presence of unknown, potentially modifiable, drivers of neuroworsening.

Authors/Disclosures
Markus E. Harrigan PRESENTER	Mr. Harrigan has nothing to disclose.
	No disclosure on file
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	No disclosure on file
Jan M. Schwab, MD, PhD (Ohio State University)	Dr. Schwab has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Wings for Life Spinal Cord Injury Foundation. The institution of Dr. Schwab has received research support from NIH, WfL, CHNF. Dr. Schwab has received intellectual property interests from a discovery or technology relating to health care.