NEUROLOGICAL LEVEL EFFECT ON THE DISCHARGE FUNCTIONAL STATUS OF SPINAL-CORD INJURED PERSONS AFTER REHABILITATION

Objective: To determine the relation between neurological level and fu nctional status, measured by individual Functional Independence Measur e (FIM) item scores, at discharge after rehabilitation in individuals with acute spinal cord injury (SCI). Design: A cohort of spinal cord i njured individuals (ASIA Impairment Scale grades A, B, and C) were cla ssified in groups for analysis of variance (ANOVA) according to neurol ogical level at discharge (C1-4, C5, C6, C7-8, T1-6, T7 and below). Se tting: A 20-bed SCI rehabilitation unit. Patients: One hundred twelve individuals admitted between January 1993 and December 1996. Intervent ion: Multidisciplinary rehabilitation program. Main Outcome Measures: FIM item scores at discharge after rehabilitation. Results: ANOVA and post hoc testing showed significant differences and a systematic chang e in discharge FIM item scores between adjacent neurological groupings for the tetraplegic and T1-6 paraplegic groups for all the self-care items and between the high and low paraplegic groups for the mobility items. A systematic relation was also seen between lesion level and di scharge FIM score for the sphincter control items but not for the loco motion and cognitive items. Conclusions: The finding of an inverse rel ationship between FIM score and neurological level for certain motor i tems supports clinical observations that functional performance in spi nal cord injured individuals is reduced with greater neurological impa irment. However, results for the locomotion and cognitive subscale ite ms indicate a need for other measures, in addition to the FIM, fur out come measurement in SCI. (C) 1998 by the American Congress of Rehabili tation Medicine and the American Academy of Physical Medicine and Reha bilitation.