Abstract
It is widely accepted that early rehabilitation programs are required for patients with spinal cord injury (SCI) immediately after injury. However many patients with SCI are admitted to rehabilitation facilities only after a long interval in Japan. The purpose of this study was to investigate how early rehabilitation contributes to improve their activities of daily living (ADLs) in Japan. The present multicenter study examined the status of SCI rehabilitation in Japan, and sought to determine the natural course of SCI and the effect early intervention has on rehabilitation. Sixteen Rosai hospitals and one college of medicine participated in our study. One hundred twenty-three SCI patients (admitted between April 1994 and March 1997, 104 men, 19 women; mean age, 48.8±17.7yr) were divided into an early rehabilitation group and a delayed group and were retrospectively assessed by using the American Spinal Cord Injury (ASIA) and International Medical Society of Paraplegia (IMSOP) classification of ASIA/IMSOP 1992 version. The motor recovery rate (MRR) was defined as (ASIA motor score at discharge-ASIA motor score at admission)/(100-ASIA motor score at admission). The regression lines for FIMTM instrument score and ASIA motor score were determined for 6 subgroups (early or delayed tetraplegia, central cord injury, paraplegia) by the MRR staging. The regression lines for physical or cognitive FIM score and ASIA motor score were also determined for 6 subgroups. Three stages were obtained: acute stage: 2 weeks postinjury; recovery stage: 2 weeks to 6 months postinjury; and chronic stage: more than 6 months postinjury. Regression lines showed that rehabilitation improved physical functional independence for ASIA motor score, especially in the early rehabilitation subgroups. There was no correlation between cognitive FIM score and ASIA motor score in 6 subgroups. The present findings suggested that SCI rehabilitation contributed to good ADLs for motor function and early SCI rehabilitation hastens and promotes improvement in ADLs by enhancing ADLs for function.
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