University Hospital Balgrist, Spinal Cord Injury Center, Forchstrasse, Zurich, Switzerland.
Zurich University of Applied Sciences, Winterthur, Switzerland.
Spinal Cord. 2018 Feb;56(2):158-167. doi: 10.1038/s41393-017-0007-5. Epub 2017 Oct 23.
Prospective observational multicenter study.
Investigation of content, duration and adjustment of physical therapy for the rehabilitation of ambulation in acute spinal cord injury (SCI).
European Multicenter Study of SCI (EMSCI).
Physical therapy interventions during acute in-patient rehabilitation of eighty incomplete SCI patients (AIS B, C, D all lesion levels) were recorded using the SCI - Intervention Classification System. Mobility was documented using the Spinal Cord Independence Measurement (SCIM III), demographics and clinical data were retrieved from the EMSCI database.
Overall recovery of locomotor function was categorized into three outcome groups (G1-G3). Of 76 initial wheelchair-using patients, 53.9% remained wheelchair user (G1), 25% regained moderate (G2) and 21.1% good walking (G3) capability. Strength training was the most frequently applied intervention of body function/-structure across all outcome groups (about 30% of all interventions), while interventions focusing on muscle tone and respiration were predominantly applied in wheelchair-dependent patients. Activity-focused interventions of transfer, transition, sitting were trained most intensively in outcome group G1, while walking and swimming were increasingly trained in patients with moderate and good walking outcomes. Physical therapy interventions of assistive and active trainings as well as corresponding training environments changed with the recovery of locomotor function.
Physical therapy of locomotor function is targeted to individual patients' conditions and becomes adjusted to the progress of ambulation. Although the involved clinical sites were not following explicitly standardized rehabilitation programs, common patterns can be discerned which may form the basis of prospective standardized programs.
前瞻性观察性多中心研究。
研究急性脊髓损伤（SCI）康复中物理治疗的内容、持续时间和调整。
欧洲多中心 SCI 研究（EMSCI）。
使用 SCI 干预分类系统记录 80 例不完全性 SCI 患者（AIS B、C、D 所有损伤水平）在急性住院康复期间的物理治疗干预措施。使用脊髓独立性测量（SCIM III）记录运动能力，从 EMSCI 数据库中检索人口统计学和临床数据。
运动功能的总体恢复分为三个结果组（G1-G3）。在 76 名最初使用轮椅的患者中，53.9%仍为轮椅使用者（G1），25%恢复中度（G2），21.1%恢复良好行走（G3）能力。力量训练是所有结果组中最常用的身体功能/结构干预措施（约占所有干预措施的 30%），而专注于肌肉张力和呼吸的干预措施主要应用于依赖轮椅的患者。在结果组 G1 中，转移、过渡、坐姿等以活动为重点的干预措施得到了最集中的训练，而在中度和良好行走结果的患者中，行走和游泳的训练逐渐增加。辅助和主动训练以及相应的训练环境的物理治疗干预措施随着运动功能的恢复而进行调整。
运动功能的物理治疗针对患者的个体情况，并根据步行能力的进展进行调整。尽管涉及的临床站点没有遵循明确的标准化康复方案，但可以看出共同的模式，这些模式可能构成未来标准化方案的基础。
