Functional outcomes after spinal cord injury: a multidisciplinary approach

The knowledge of spontaneous clinical evolution and the availability of models to predict the recovery of functional outcomes play a key role in the design of a successful rehabilitative plan after spinal cord injury (SCI). Reliable information about prognosis constitutes the basis to counsel patients and caregivers, to establish shared rehabilitative aims between patient and rehabilitation team and to timely and successfully plan discharge and social reintegration. The aim of the PhD project is to deepen the knowledge of spontaneous evolution and the prediction of functional outcomes after SCI. The research was structured in 7 subprojects: 1. The first subproject was focused on the study of the role of neurophysiological parameters in the prediction of global functional outcome after traumatic cervical SCI. Our study demonstrates that neurophysiological assessment improves the prediction of functional prognosis after traumatic cervical SCI, and suggests the use of neurophysiology to optimize patient information, rehabilitation, discharge planning and the design of future clinical trials. 2. The second subproject was focused on the validation in patients affected by ischemic SCI of two models previously developed for the prediction of bladder outcome after traumatic SCI. Our study demonstrates that also in ischemic SCI the outcome of full bladder function recovery can be predicted by clinical scores. 3. The third subproject was focused on the development of a valid model to predict bowel outcome after traumatic spinal cord injury, which may be applied to clinical and research purposes. 4. The fourth subproject was focused on the validation of the bowel outcome prediction model in an independent sample of patients with traumatic SCI. 5. The fifth subproject was focused on the validation of the bowel prediction model in patients affected by ischemic SCI. Our study demonstrates the validity of our bowel prediction model also in patients with ischemic SCI. 6. The sixth subproject was focused on the evaluation of functional outcomes after central cord syndrome. In contrast to previous reports, our study demonstrates that people with central cord syndrome have poorer outcomes of self-care ability compared with patients with other incomplete cervical SCI. 7. The seventh subproject was focused on the evaluation of the measurement properties of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) in the assessment of patients with non-traumatic SCI. Our study fills a gap in the assessment of SCI, demonstrating that the ISNCSCI are a valid and reliable tool also for the evaluation of patients with non-traumatic SCI. This PhD project has deepened a few important aspects related to clinical evolution and prognosis of patients with traumatic and non-traumatic SCI. The results of this project may have positive consequence in the care of patients with SCI and in the design of future clinical trials in this research field.