Neurological level effect on the discharge functional status of spinal cord injured persons after rehabilitation

Abstract

Objective: To determine the relation between neurological level and functional status, measured by individual Functional Independence Measure (FIM) item scores, at discharge after rehabilitation in individuals with acute spinal cord injury (SCI). Design: A cohort of spinal cord injured individuals (ASIA Impairment Scale grades A, B, and C) were classified in groups for analysis of variance (ANOVA) according to neurological level at discharge (C1-4, C5, C6, C7-8, T1-6, T7 and below). Setting: A 20-bed SCI rehabilitation unit. Patients: One hundred twelve individuals admitted between January 1993 and December 1996. Intervention: Multidisciplinary rehabilitation program. Main Outcome Measures: FIM item scores at discharge after rehabilitation. Results: ANOVA and post hoc testing showed significant differences and a systematic change in discharge FIM item scores between adjacent neurological groupings for the tetraplegic and T1-6 paraplegic groups for all the self-care items and between the high and low paraplegic groups for the mobility items. A systematic relation was also seen between lesion level and discharge FIM score for the sphincter control items but not for the locomotion and cognitive items. Conclusions: The finding of an inverse relationship between FIM score and neurological level for certain motor items supports clinical observations that functional performance in spinal cord injured individuals is reduced with greater neurological impairment. However, results for the locomotion and cognitive subscale items indicate a need for other measures, in addition to the FIM, for outcome measurement in SCI.