SCI
Edel Auh, MD
Resident Physician
Northwestern McGaw / Shirley Ryan AbilityLab
Chicago, Illinois, United States
Stephanie Hendrick, MD
Assistant Professor of Physical Medicine and Rehabilitation
Northwestern University Feinberg School of Medicine / Shirley Ryan AbilityLab
Chicago, Illinois, United States
Edel Auh, MD
Northwestern McGaw / Shirley Ryan AbilityLab
Chicago, Illinois, United States
Predicting the likelihood of ambulation after traumatic spinal cord injury (SCI) is difficult given the unpredictable nature of neurorecovery. Studies have shown that the American Spinal Injury Association Impairment Scale (AIS) has the best prognostication accuracy for independent ambulation.
Case Description:
Our patient is a 33-year-old male with SCI secondary to crush injury. Initial examination performed twenty days post-injury demonstrated T12 AIS A with motor zone of partial preservation (ZPP) to S1 and sensory ZPP to S2 with notable intact pinprick sensation at S1 bilaterally. With high intensity gait training during inpatient rehabilitation, he progressed from ambulating with knee ankle foot orthotics and rolling walker to ambulating 150 feet with ankle foot orthotics (AFOs) and loftstrand crutches despite limitations in sensation and lack of plantarflexion control. With continued outpatient therapies, he is now a full-time community ambulator using unilateral crutch and anterior-shell AFOs.
Discussions:
Studies have reported between 0 to 8.5% chance for AIS A patients to achieve independent ambulation. These odds may increase if a patient converts to an incomplete SCI with the highest likelihood of ambulation for AIS D. However, despite remaining AIS A, our patient’s neurorecovery has progressed to functional community ambulation, likely due to his prominent ZPP. Furthermore, a study by Smith et al. demonstrated pinprick sensation at S1 to be a clinical prediction rule for independent walking one year after SCI. Although this study focused on incomplete SCI, the findings also apply to our patient’s recovery of ambulation based on his sensory exam. The importance of adapting rehabilitation goals to match patient presentation and recovery trajectory cannot be understated.
Conclusions:
Although there are guidelines for ambulation potential after SCI, the presence of a large ZPP may alter predictions even for patients with complete injuries. In these cases, special considerations are needed to better guide complex prognostics and rehabilitation goals.
