Showing papers by "Ralph J. Marino published in 1999"

The relationship between the functional abilities of patients with cervical spinal cord injury and the severity of damage revealed by MR imaging.

Abstract: BACKGROUND AND PURPOSE: The appearance of the damaged spinal cord after injury correlates with initial neurologic deficit, as determined by the American Spinal Injury Association grade and manual muscle test score, as well as with recovery, as assessed by manual muscle test scores. The purpose of this study was to determine whether the presence of spinal cord hemorrhage and the size and location of spinal cord edema on MR images is predictive of functional recovery in survivors of cervical spinal cord injury (SCI). METHODS: The degree of damage to the cervical spinal cord was measured on the MR images of 49 patients who underwent imaging within 72 hours of sustaining SCI. The effects of hemorrhage and length/location of edema on changes in the value of the motor scale of the functional independence measure (FIM) were assessed on admission to and discharge from rehabilitation. RESULTS: Patients without spinal cord hemorrhage had significant improvement in self-care and mobility scores compared with patients with hemorrhage. There was no significant effect of spinal cord hemorrhage on changes in locomotion and sphincter control scores. The rostral limit of edema positively correlated with admission and discharge self-care scores and with admission mobility and locomotion scores. Edema length had a negative correlation with all FIM scales at admission and discharge. CONCLUSION: The imaging characteristics of cervical SCI (hemorrhage and edema) are related to levels of physical recovery as determined by the FIM scale. Imaging factors that correlate with poor functional recovery are hemorrhage, long segments of edema, and high cervical locations.

Development of a short-form Quadriplegia Index of Function scale.

Abstract: Objective: To develop a short-form version of the Quadriplegia Index of Function (QIF) that would be more practical to use than the original version. Design: Cross-sectional data collected at 6 months post spinal cord injury. Setting: Regional Spinal Cord Injury Center. Patients: Consecutive sample of 95 patients with tetraplegia, non-ambulatory at 6 months, admitted to a regional SCI center between December 1987 and August 1992. Methods: A short-form QIF was developed by using regression analysis to determine the best six items that would predict the sum of the 37 items selected from seven mobility and self-care categories of the original scale. This short-form QIF was evaluated for internal consistency and discriminant validity. Validity of the short-form QIF was assessed by correlation with motor scores and using analysis of variance by motor levels and motor score groupings. Results: Regression analysis identified the following items as best predictors of the 37-item QIF score: (1) wash/dry hair, (2) turn supine to side in bed, (3) put on lower body clothing, (4) open carton/jar (feeding), (5) transfer from bed to chair, and (6) lock wheelchair. These items explained 99% of the variance in total scores. Short-form QIF scores (simple sum of the six best items) ranged from 0 to 24, with a median score of seven, interquartile range 0–16. Item response patterns were largely dichotomous. Item-total correlations ranged from 0.60 to 0.80; Cronbach's alpha was 0.89. Spearman correlation coefficient between upper extremity motor score and short-form QIF was 0.82. Analysis of variance indicated that the motor score groupings and motor levels accounted for 63 and 54% of the variance in short-form QIF scores, respectively. Post hoc analyses indicated that motor levels from C5 to T1 had different mean QIF scores, except for C7 versus C8. There may be ceiling effects for individuals with low level injuries. Conclusion: There is significant redundancy in the QIF. Six items, selected from five categories, yield results comparable to the 37-item QIF. The short-form QIF must next be assessed for sensitivity to change. A brief disability measure would improve data quality and completeness, and may permit ongoing collection of observational rather than self-report data.

A functional strategy for classifying patients after traumatic spinal cord injury.

Abstract: Objectives: To present a function-based strategy for classifying patients by expected functional outcomes measured as patients' performances at discharge on each of the 18 component items of the FIM™ instrument (previously known as the Functional Independence Measure). Methods: Data included records from 3604 inpatients with traumatic spinal cord injury discharged from 358 rehabilitation units or hospitals in 1995. The function-based strategy assigned patients to four Discharge Motor-FIM-Function Related Groups defined by patients' admission performance on the motor-FIM items. Results: The majority of patients whose motor-FIM scores at admission were above 30 were able to groom, dress the upper body, manage bladder function, use a wheelchair, and transfer from bed to chair, either independently or with supervision, by the time of discharge from inpatient rehabilitation. Most patients whose scores were above 52 attained independence in all but the most difficult FIM tasks, such as bathing, tub transfers, and stair climbing. Conclusions: This classification scheme can be used to determine the degree to which patients' actual FIM outcomes compare to other individuals who had similar levels of disabilities at the time of admission to rehabilitation. The clinician can apply these `FIM item attainment benchmarks' retrospectively in quality improvement, in guideline development, and in anticipating the types of post-discharge care required by clinically similar groups.

Guidelines for outcome studies in electrodiagnostic medicine

Abstract: Based on a review of the literature and the clinical research and experience of the authors and reviewers, the American Association of Electrodiagnostic Medicine proposes 17 criteria which should be used to construct and evaluate diagnostic and/or therapeutic outcome studies for patients with symptoms and signs of neuromuscular diseases. Neuromuscular diseases are defined as diseases that cause pathology and/or dysfunction of the sensory, motor, and/or autonomic nerve fibers and/or muscles.