Establishing prognosis and maximizing functional outcomes after spinal cord injury - A review of current and future directions in rehabilitation management

Study Design. Review article. Objectives. To review the medical literature and provide a framework for predicting neurorecovery and functional outcomes after spinal cord injury based on injury severity. Summary of Background Data. The ability to accurately predict the magnitude of neurorecovery and expected functional outcomes after spinal cord injury is of great importance. This information is needed to justify medical and rehabilitation interventions to third party payers as well as to begin the process of planning for postdischarge care. Over the past several decades, significant progress has been made in accurately predicting neurorecovery and its impact on functional outcomes. Methods. Structured review of published reports obtained through MED-LINE search and texts. Results/Conclusion. Within 72 hours to 1 month after a spinal cord injury, it is possible to predict with reasonable accuracy the magnitude of expected recovery based on physical examination. The impact of motor level on long-term functional outcomes is also clear and has remained relatively unchanged for several decades. Functional outcomes are likely to improve in upcoming years as novel interventions, such as drugs and functional neuromuscular stimulation, are developed with the goals of limiting secondary injury and restoring neurologic function. New training methods, such as body weight support, that use activity-dependent neuroplasticity will also have a more prominent role.