REHABILITATION OF INCOMPLETE SPINAL-CORD PATHOLOGY FACTORS AFFECTING PROGNOSIS AND OUTCOME

To determine the factors affecting the outcome of patients with incomp lete spinal cord lesions, a retrospective study was performed of al su ch patients (n = 49) admitted to the neurorehabilitation unit of the N ational Hospital for Neurology and Neurosurgery, London, over a 2-year period. Disability on admission and discharge as measured by the Func tional Independence Measure (FIM), change in disability, presence or a bsence of neurological recovery, patient age, level of the lesion and length of inpatient stay were the main outcome measures. Data were com plete on 39 patients. There were 20 patients with cervical myelopathy, 15 with intrinsic cord abnormalities including syrinxes, 7 with spina l cord infarcts and 7 with other conditions such as tropical spastic p araparesis and hereditary paraparesis. Age ranged from 17 to 88 years (mean 53). Mean duration of stay was 40 days and the duration was rela ted to the diagnosis. Nineteen of the patients made some neurological improvement, while all but one improved on the FIM. This functional ga in did not correlate with the patients' age, initial disability or lev el of the lesion, but was related to the length of stay in the unit, a nd neurological improvement. We conclude that the needs of patients wi th progressive incomplete spinal cord lesions due to neurological dise ase differ from those of patients with acute traumatic spinal cord les ions and are best managed in a neurological rehabilitation unit. Effic acy appears to be related to neurological recovery and the duration of rehabilitation. This study underlines the value of combined neurologi cal and rehabilitation expertise in the management of this patient gro up and the need to incorporate both disciplines in planning service pr ovision.