Identification of clinical and rehabilitation groups among patients with cervical tetraplegia

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 C4D1level aged 1860 years in whom changes in clinical and functional status were monitored for 57 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 C6and 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 C4C6(functionally dependent), patients with a low level of damage to C7D1(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.