Identification of clinical and rehabilitation groups among patients with cervical tetraplegia

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Abstract

BACKGROUND: Spinal cord injury at the cervical level often leads to a severe neurological deficit, such as tetraplegia (International Standards for Neurological Classification of Spinal Cord Injury) and gross functional disorders. Currently, methods of differentiated rehabilitation strategy are developed, taking into account the needs of the patients.

AIMS: This study aimed to examine the clinical heterogeneity of patients with a cervical injury and to form appropriate clinical and rehabilitation groups based on common relevant rehabilitation goals.

MATERIALS AND METHODS: We examined 190 patients with severe cervical myelopathy C4–D1 level aged 18–60 years in whom changes in clinical and functional status were monitored for 5–7 years. The rehabilitation program was standardized and based on existing national clinical guidelines for physical rehabilitation in patients with spinal cord injuries.

RESULTS: The greatest changes were in patients with motor levels C6 and C7. Patients with cervical tetraplegia, according to the criterion of functional and motor homogeneity, can be divided into four clinical and rehabilitation groups: patients with a high level of damage to C4–C6 (functionally dependent), patients with a low level of damage to C7–D1 (functionally independent), patients with complete motor damage (types A and B), and patients with incomplete motor damage (types C and D).

CONCLUSIONS: The allocation of clinical and rehabilitation groups allows the prediction of the results and outcomes of rehabilitation. A timely rehabilitation prognosis can improve the quality of life of patients with cervical tetraplegia and their families and contribute to their timely adaptation to society.

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About the authors

Fedor A. Bushkov

Rehabilitation Center “Overcoming”

Email: bushkovfedor@mail.ru
ORCID iD: 0000-0002-3001-0985
SPIN-code: 7593-3400

MD, Cand. Sci. (Med.)

Russian Federation, Moscow

Aleksandr N. Razumov

Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine

Author for correspondence.
Email: razumov_a_n@staff.sechenov.ru
ORCID iD: 0000-0001-5389-7235
SPIN-code: 8793-5173

MD, Dr. Sci. (Med.), Professor, Academician of the Russian Academy of Sciences

Russian Federation, Moscow

Nino V. Sichinava

Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine

Email: sichi.24@mail.ru
ORCID iD: 0000-0002-7732-6020
SPIN-code: 2568-8150

MD, Dr. Sci. (Med.), Senior Research Associate

Russian Federation, Moscow

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Supplementary files

Supplementary Files
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1. Fig. 1. Dependence of functional status (FIMm and VLT) on motor level and completeness of spinal cord injury (Mn, 0.95% CI) d at the beginning of the observation period (Т1).

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2. Fig. 2. Dependence of the functional status (FIM and VLT) on the motor level and completeness of the spinal cord injury (Mn; 0.95% CI) after the observation period (Т2).

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