PROGNOSIS FOR NEUROLOGIC RECOVERY
One of the most challenging aspects of rehabilitation medicine is talking with patients and families regarding prognosis for recovery. We must be able to present the best available information regarding prognosis (which is often not good) in a manner that people with varied levels of education and sophistication can understand and offer a reasonable and realistic degree of hope.
Spinal cord injury is truly devastating, and as rehabilitation specialists, we must take the impact of that into account when communicating with patients and families. We must also be aware that during these times of stress, communication may not always be effective. We must also be clear that neurologic recovery can be markedly different from functional recovery.A complete spinal cord injury examination is necessary for any discussion of prognosis. Examination at least 72 hours after injury has been determined to be a better prognostic indicator than earlier examinations (13-15). (This does not mean earlier examinations are not necessary, only that they are of less prognostic value, as they may be limited for a variety of reasons.)
Most recovery from spinal cord injury occurs during the first six months, with a plateau reached around nine months postinjury, though later recovery can occur. Neurologic recovery after a complete injury is poor. Ninety-six percent of those with complete paraplegia and 90% with complete tetraplegia at one month will remain ASIA-A. Muscle groups with a grade of 0 at initial examination are unlikely to regain functional strength. Muscles with grades 1-2 have a 64% chance of increasing to functional strength in paraplegia and 97% in tetraplegia. Incomplete paraplegia has an average motor score increase of 12 points at one year postinjury. Seventy-six percent of those with incomplete paraplegia became community ambulators. For incomplete tetraplegia, 46% became community ambulators at one year (16).