Showing papers by "Ralph J. Marino published in 2012"
TL;DR: The presence of intramedullary hemorrhage and extended segments of edema have been associated with clinically complete SCI, and magnetic resonance imaging (MRI) provides valuable adjunct information when a bedside clinical assessment cannot be completed.
Abstract: Spinal cord injury (SCI) is a sudden, life-altering event. Injury severity and accompanying recovery vary considerably from individual to individual. The most important determinant of prognosis is whether an injury is clinically complete or incomplete. While approximately 10-20% of complete injuries convert to incomplete during the first year post-injury, the magnitude of motor recovery following complete SCI is limited or absent. Robust functional motor recovery (e.g., weight-bearing, ambulation) distal to the zone of injury is rare. Recovery following incomplete SCI is particularly variable, and anywhere from 20% to 75% of individuals will recover some degree of walking capacity by 1 year post-injury. This is related to presenting injury severity (American Spinal Injury Association Impairment Scale grade); however, even 20-50% of individuals who present as motor complete, sensory incomplete will walk in some capacity by 1 year post-injury. Regardless, for both complete and incomplete injuries, the majority of recovery is observed during the initial 9-12 months, with a relative plateau reached by 12-18 months post-injury. Magnetic resonance imaging (MRI) provides valuable adjunct information when a bedside clinical assessment cannot be completed. The presence of intramedullary hemorrhage and extended segments of edema have been associated with clinically complete SCI.
83 citations
TL;DR: The CUE-T displays good internal consistency and excellent construct validity on preliminary testing, and push/pull tests should be revised to increase difficulty.
Abstract: OBJECTIVE This study aimed to describe the development, internal consistency, and validity of the Capabilities of Upper Extremity Test (CUE-T) for persons with tetraplegia. DESIGN This study used a cross-sectional sample of adults with spinal cord injury. CUE-T items and procedures were developed based on the CUE Questionnaire. Thirty adults with complete and incomplete spinal cord injury, neurologic levels C4-T6, were tested on one occasion. Each received upper limb manual muscle testing and the CUE Questionnaire followed by the CUE-T. Raw item scores were converted to a 0-4 scale. Internal consistency was evaluated using Cronbach alpha. Item score distributions were evaluated for ceiling and floor effects. Spearman correlations of total, right, and left CUE-T scores with upper-limb motor scores and international hand classification were performed. RESULTS There were 23 men and 7 women, with an average age of 44.8 yrs. Twenty subjects had motor complete injuries; 13 had motor levels C4-C6, 13 had between C7 and C8, and 4 were T1 or below. The Cronbach alpha for the CUE-T was 0.96. Item score distributions found ceiling effects for the push/pull items, suggesting that these items were too easy. Correlations of right- and left-sided scores with upper-limb motor scores and international hand classification were strong, with all values greater than or equal to 0.89. CONCLUSIONS The CUE-T displays good internal consistency and excellent construct validity on preliminary testing. Push/pull tests should be revised to increase difficulty. Reliability and responsiveness should be determined.
39 citations
TL;DR: The FIM at discharge has predictive value for long-term outcomes, and improvement in FIM suggests reduced economic burden in SCI patients.
Abstract: Association between the Functional Independence Measure following spinal cord injury and long-term outcomes
28 citations