Effects of early mobilization within 48†hours of injury in patients with incomplete cervical spinal cord injury.

OBJECTIVE: To investigate the effects of early mobilization within 48 h of injury on motor function and walking ability in patients with incomplete cervical spinal cord injury (SCI). DESIGN: A retrospective observational study. SETTING: Intensive care unit or high care unit of a university hospital emergency center. PARTICIPANTS: Of 224 patients with SCI having American Spinal Injury Association impairment scale grades C and D, 158 consecutive patients hospitalized for at least 3 weeks after injury were included. INTERVENTIONS: Patients were categorized into two groups: an early mobilization group in which patients were mobilized within 48 h of injury and a delayed mobilization group in which they were mobilized after 48 h of injury. OUTCOME MEASURES: The upper extremity motor score (UEMS), lower extremity motor score (LEMS), and Walking Index for Spinal Cord Injury II (WISCI II) were compared using propensity score matching analysis. RESULTS: Of the 158 patients who met the eligibility criteria, 32 were matched between the groups. There was a significant difference in the change in LEMS from the initial assessment to the assessment 2 weeks postoperatively in the early mobilization group (median 9 points vs. 3 points, p < 0.05). There were no significant differences in UEMS or WISCI II. CONCLUSION: Early mobilization within 48 h may improve lower extremity motor function in patients with acute incomplete cervical SCI.

Reliability and validity of classification of senile postural deformity in mass examinations.

Nakada (1988) divided senile postural deformities into four types by visual observation: an extended type, an S-shaped type, a flexed type, and a hand-on-the-lap type. The purpose of this study was to investigate the inter-rater reliability and the discriminant validity of assessing the elderly spinal posture using a posture-measuring device developed by us and dividing postural deformities into the four types of Nakada's classification. Seventy-seven elderly persons (52 women and 25 men) who lived independently participated in the study. The average age of the subjects was 73 years (range, 65 to 84 years). The type of the senile postural deformity was determined by three judges using our posture-measuring device in combination with Nakada's classification. The rate of agreement of the classification was 92.2%. This method had a significantly high rate of inter-rater reliability. The thoracic kyphotic angle was larger in the S-shaped type than in the normal, extended type, and flexed type. The lumbar lordotic angle was also larger in the S-shaped type than in the extended type, flexed type, and hand-on-the-lap type. In the hand-on-the-lap type, the mean of the lumbar lordotic angle was much smaller. The lumbosacral angle was smaller in the extended type than in the normal, S-shaped type, and flexed type. With the analysis of x-ray photographs, this method appeared to have discriminant validity as a measure of senile postural deformity. The combination of our posture-measuring device and Nakada's classification would be useful to classify senile postural deformities in mass examinations.