Effect of early rehabilitation intervention on the recovery time after spinal cord injury

English Keywords:Spinal cord injury  Early rehabilitation  Rehabilitation time  Complication  ASIA impairment scale

English Abstract:

  【Abstract】 Objectives: To investigate the effect on the required rehabilitation time(RT), the change of ASIA impairment scale(AIS) and the incidence of complications of the starting time of treatment on rehabilitation after spinal cord injury. Methods: A collaborative prospective and follow-up study was performed. After the patients entered the study, the goal and plan of rehabilitation were set according to the international standard immediately, and rehabilitation training was then started. Through prospective observation, the RT, from onset injury to the time point when reaching the rehabilitation goal, was recorded. AIS changes and complications were also recorded. From January 2009 to December 2012, 521 cases of traumatic SCI were totally recruited, the average age was 38.5±12.1(range, 18-74) years old, there were 419 males and 102 females, with a mean follow-up time of 20±8(range, 10-38) months. The patients were divided into peri-operation, post-operation and delayed rehabilitation groups with respect to the starting time of rehabilitation. The cases in each group were further designated as upper cervical SCI, lower cervical SCI, thoracic SCI and lumbar-sacral injury according to the injury levels. The results of RT, AIS and complications among three groups were analyzed. Results: In peri-operation group, the median of RT for upper and lower cervical SCI, thoracic SCI and lumbar-sacral injury cases after complete motor injury was 238d, 160d, 97d and 62d, respectively, while 153d, 128d, 72d and 46d respectively for incomplete motor injury cases. There were 16-30 days increase of RT in post-operation group(P<0.05). Compared with the other two groups, further RT extension were found in the delayed group. For lower cervical SCI, thoracic SCI and complete motor lumbar sacral injury cases, the RT in the delayed group even doubled as long as that of the peri-operation group(P<0.05). When reaching rehabilitation goals, 3.8%, 13.6%, 34% and 7.7% of the Grade A, B, C and D cases respectively achieved one grade of improvement, while 2.35%, 2.1%, 0.09% and 0% of the Grade A, B, C and D cases respectively got two grades improvement. Early rehabilitation could decrease the incidence of sore, deep vein thrombosis, lower urinary tract infection and lung infection to 6.2%, 5.5%, 15.4% and 11.1% respectively in the peri-operation group. Conclusions: Early rehabilitation decreases the incidence of complications, shortens the RT of SCI patients. Rehabilitation training, no matter starting early or late, has equal effect on the improvement of AIS.