II POSTER PRESENTATIONS

Topic 2: Prognostication of Physical Outcome

12 Patient monitoring during spinal cord injury rehabilitation

S de Groot, A Dallmeijer, O Kilkens, M Post, E Angenot, F van Asbeck, H
Bongers, A Nene, D van Kuppevelt, H Slootman, D Mulder, T Sluis, M Bergen,
A Niezen, H Rijken, F Woldring, K Postma, J Bloemen, L Valent, S van
Langeveld, M Schuitemaker, L van der Woude
Rehabilitation Center Amsterdam
Institute of Fundamental and Clinical Human Movement Sciences

Purpose: Over the past 5 years a Dutch multi-center study ‘Restoration of mobility in
spinal cord injury (SCI) rehabilitation’ investigated the development and outcome of the
rehabilitation process of people with a SCI. The next step is to implement part of the
developed test battery in rehabilitation to systematically monitor functional progress of
the patients. These data will be used during team communications to optimize
individual rehabilitation strategy and the SCI rehabilitation program in general.

Methods: The project is set up in a strong collaboration between physicians and
paramedical research assistants of 8 rehabilitation centers with a specialized SCI unit
and with researchers in the SCI field. It is approved by the Dutch-Flemish Society of
Paraplegia. Patients will be measured at least three times during clinical rehabilitation
(start, 3 months later, discharge). The implemented tests measure the wheelchair
skills, physical capacity, hand functioning, lung functioning, muscle strength, and
independence in daily living. For good interpretation of the test results, norm data will
be developed using the data of the multi-center study.

Discussion: Clear manuals and test forms are developed for standardization of the
tests, which is required for comparison of results within and between patients.
Continued schooling and discussions are required to support and to optimally interpret
the individual test results in the clinical context.

14 Factors related to employment status in traumatic spinal cord injury
persons: a 4 year follow-up.

M.C. Pagliacci, B. Di Clemente, A. Rampello, M. Agosti, M. Franceschini
Unit of Rehabilitation, Department of Geriatrics and Rehabilitation, University
Hospital, Parma, Italy.

The aim of this study was to evaluate the employment condition of persons with
traumatic spinal cord injury 4 years after discharge from rehabilitation facilities, as well
as the factors related to better outcome. In the follow-up we interviewed 403 persons
using a standardised telephone questionnaire. We recorded the following variables:
current employment status, causes of unemployment. We looked for the correlation
between employment status and demographic status (age, gender, marital status),
clinical status (level and completeness of lesion, complications, re-admissions,
autonomy in bladder and bowel management) and other information (ability to drive,
feeling of dependency, quality of life).

In our results 51.4% of the interviewed persons were unemployed, 34.7% had a job
and 7.2% were students.

Among the unemployed persons 34% had suffered an accident at work, 31% had been
unable to find suitable work and 31% were retired.

Employment significantly correlated with younger age, single status, being paraplegic,
suffering a lower percentage of complications and re-admissions, being autonomous in
bladder/bowel management and driving a car, having a lower feeling of dependency
and a better quality of life. In the multivariate analysis the factors predicting better
outcome were younger age, ability to drive and a better quality of life.

15 A COMPLETE SPINAL CORD-INJURED PATIENT WITH NORMAL
MOTOR AND SOMATOSENSORY EVOKED POTENTIAL FINDINGS –
CASE STUDYJH

Kim , SY Lee, IS Choi, SG Lee
Department of Physical Medicine and Rehabilitation, Research Institute of
Medical Sciences, Chonnam National University Hwasun Hospital, Gwangju City, Korea

Introduction: In spinal cord-injured patient, the dissociation between the clinical
findings and electrophysiologic findings is extremely rare in completeness of injury. We
want to report a case with a complete cervical cord injury mismatched with the evoked
potential studies presented as normal findings.

Case: A 31-year-old male who undergone traffic accident was presented with complete
tetraplegia. On neurological examination suggested by ASIA, he was diagnosed as
ASIA-A tetraplegia with motor (C5/C5) and sensory (T7/T7) function. Owing to the
spontaneous recovery and rehabilitation management, he gained normal upper limb
function during the initial hospitalization of 3 months and became an ASIA-A paraplegia
with motor (T1/T1) and sensory (T7/T7) function. CT scan showed the fracture of right
posterior arch of C1 and thoracolumbar MRI showed normal finding. Urodynamic study
showed the areflexic, atonic and hypoactive neurogenic bladder. Initial and regular
follow-up electrophysiologic studies including of median-SEP, tibial-SEP, pudendal-
SEP and MEP studies reveal consistently normal findings. Social work-up assessment
revealed that he had a good occupation and socioeconomic status irrespective of
secondary gains. Neuropsychiatric assessment for the exclusion diagnosis of
conversion disorder or malingering, confirmed that he did not have any
neuropsychiatric illness.

Conclusion: We think the mismatch of completeness between the ASIA diagnosis and
evoked potential studies may exist, possibly owing to the existing conductible neural
fibers in spite of the anesthesia on S2-4 sensory dermatomes and paralysis on
paralyzed body.

16 Osteoporosis Study in Complete Spinal Cord Injured (SCI) Men.
Comparison with Data of Healthy Men

1,2Y.DIONYSSIOTIS, 2G.TROVAS, 2P.RAPTOU, 2A.GALANOS, 2G.KINIKLIS,
2G.P.LYRITIS and 1K.PETROPOULOU
1 2nd Rehabilitation department National Rehabilitation Center Athens ,Greece.
2 Laboratory of Research Musculoskeleletal system KAT hospital Athens, Greece

Aim: To compare changes in bone parameters in SCI men and able-bodied controls
and to assess the influence of positive and negative factors in SCI men in
osteoporosis.

Subjects and Methods: We studied 24 men:16 complete SCI in chronic stage( >1,5
yrs) separated in group A (T4-T7 level) and group B ( T8-T12 level) in comparison with
8 healthy men as control group of similar age, height, and weight. Mean age in all
cases 32,3 yrs. All subjects were examined by peripheral quantitative computed
tomography system (p QCT-STRATEC XCT-3000) in distal epiphyses and midshafts
of the tibia.We calculated bone parameters and studied the influence of positive and
negative factors on bone structures:Age at injury,duration of paralysis(DoP), spasticity,
pharmacological treatment, , ambulation and daily activities.
pQCT Parameter Control Group Paraplegics
(group A)
Paraplegics
(group B)
Difference
Control to
group A
Difference
Control to
group B
ANOVA
p value
Tibia
Slices
subjects 8 8 8
mean ± sd mean ± sd mean ± sd
4% BMDtrb 264.15 ± 39.49 110,09 ± 59,91*** 134.58 ± 68.53 *** -58.32% -49.05% < 0,0005
BMDtot 342.01 ± 41.75 181,61 ± 48,75 *** 187.59 ± 64.79 *** -46,90% -45.15% < 0,0005
14% SSIPol2 2128.51 ± 179.35 1820.84 ± 387.16 1603.64 ± 245.53 ** -14.45% -24.66% 0.009
38% BMDcort 1108,75 ± 23,79 1087,90 ± 19,97 1057,30 ± 46,65 * -1,88% -4,64% 0,029
SSIPol3 2318.64 ± 156.95 1876.14 ± 240.31 * 1920.84 ± 141.57 * -19.08% -17.16% 0.003
THIcort 6,42 ± 0,42 5,15 ± 1,08 * 5,33 ± 0,77 * -19,78% -16,98% 0,019
66% Bone/Muscle
Area ratio
5.92 ± 0,78 10,78 ± 4.92 * 15,35 ± 5.21 ** 82.09% 159.29% 0.001
* p-value< 0,05 , ** p-value< 0,005 , *** p-value< 0,0005 of Bonferroni- tests for control group vs NLI>T7 group and vs T7<NLI<T12 group
Results- Conclusions :In group A (mean: age 26,8 yrs ,DoP : 6,3 yrs) and in group B
(mean : age 37yrs.,DoP:4,3 yrs) all bone parameters were statistical significant which
prove the existence of osteoporosis in SCI men.No significant relationships were found
between the intensity of bone loss and any of positive and negative factors .The study
is continued

18 Evaluation of Basal Status- A New Scoring System to Prognosticate
SCI Patients

D.K.Sinha, Krishna Sinha
Patna Medical College Hospital
Patna University Patna, Bihar, India

Prognostication of SCI patients depends not only on neurological level but on morbidity
caused due to 1) associated injuries 2) complications of respiratory system, 3)
complications of genito-urinary system, 4) complications of gastro intestinal system, 5)
complications of pressure areas. We need a system to evaluate the patient as per the
morbidity, which would assist us to prognosticate the medical care and rehabilitation.

Material and Methods- Keeping in view this fact, in Patna Medical College a new
scoring system of prognostication was developed as per the physical status of the
patient. Respiratory system was examined for congestion of the lung, presence of
absence of cough reflex, vital capacity of the patient by the help of One Breath Count
(OBC} The Genito urinary status was divided into two broad groups- Severities of
infection and type of Evacuation. Pressure Ulcer was evaluated as per the Number of
anatomical sites involved, Depth of the worst affected sites and Area of worst affected
site. The Gastro Intestinal status was divided into Paralytic ilius, Assisted evacuation,
Incontinent, Reflex bowel and normal bowel. Either the patient had no associated injury
or had head/abdominal/chest/multiple skeletal injury. All of them were divided into 6
grades from Critical-to-Normal condition and numerically graded from 0 to 10

A normal person gets 100 points. A patient with low OBC, without cough reflex, with
congestion of lungs in both the sides, complicated urinary tract infection, pressure sore
more than 5 anatomical sites, with associated injury of head and abdomen, his total
scoring will be zero. It will be difficult to make this patient survive or rehabilitated
whatever may be level of the lesion. Any patient getting 50 or less, his condition is poor
and great care is required to make him survive. Any score from 51 to 70 is stable but
can change for the worst if there is failure of care at any time. Any score more than 70
is good and even if he develops complication in any one system the patient is expected
to respond to treatment. This prognostication system is effective for any neurologically
involved patient in whom there may is involvement of respiratory tract, bowel, bladder
and skin and helps to plan for rehabilitation

Applicability of this Prognostication Method- We have used this Prognostication
method on more than 3000 patients and found it, easy to follow, re-producible and
comprehensible Prognostication could be done as per the total score achieved by the
patient at the time of admission. This prognostication was compared with the result
achieved till the time of discharge of the patient

Conclusion- Unlike Francal’s classification or ASIA scoring system, present evaluation
protocol gives an idea about the physical status of the patient, helps to plan the vertical
and horizontal dimension of the care and prognosticate the expected rehabilitation of
the patient.

As the evaluation is being done within possible 100 marks, it immediately helps to
understand the gradation of the given patient or compare the status between two
different patients.

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