Background: The predictors and patterns of upright mobility in children with a spinal cord injury (SCI) are poorly understood. Objective: The objective of this study was to develop a classification system that measures children’s ability to integrate ambulation into activities of daily living (ADLs) and to examine upright mobility patterns as a function of their score and classification on the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) exam. Methods: This is a cross-sectional, multicenter study that used a convenience sample of subjects who were participating in a larger study on the reliability of the ISNCSCI. A total of 183 patients between 5 and 21 years old were included in this study. Patients were asked if they had participated in upright mobility in the last month and, if so, in what environment and with what type of bracing. Patients were then categorized into 4 groups: primary ambulators (PrimA), unplanned ambulators (UnPA), planned ambulators (PlanA), and nonambulators. Results: Multivariate analyses found that only lower extremity strength predicted being a PrimA, whereas being an UnPA was predicted by both lower extremity strength and lack of preservation of S45 pinprick sensation. PlanA was only associated with upper extremity strength. Conclusions: This study introduced a classification system based on the ability of children with SCI to integrate upright mobility into their ADLs. Similar to adults, lower extremity strength was a strong predictor of independent mobility (PrimA and UnPA). Lack of pinprick predicted unplanned ambulation, but not being a PrimA. Finally, upper extremity strength was a predictor for planned ambulation.
Ditunno PL, Patrick M, Stineman M, Ditunno JF. Who wants to walk? Preferences for recovery after SCI: a longitudinal and cross-sectional study. Spinal Cord. 2008;46(7):500–506.
,
Who wants to walk? Preferences for recovery after SCI: a longitudinal and cross-sectional study
, Spinal Cord.
, vol. 46
(pg. 500
-506
) Donnelly C, Eng JJ, Hall J, et al. Client-centred assessment and the identification of meaningful treatment goals for individuals with a spinal cord injury. Spinal Cord. 2004;42(5):302–307.
,
Client-centred assessment and the identification of meaningful treatment goals for individuals with a spinal cord injury
, Spinal Cord.
, vol. 42
(pg. 302
-307
) Eng JJ, Levins SM, Townson AF, Mah-Jones D, Bremner J, Huston G. Use of prolonged standing for individuals with spinal cord injuries. Phys Ther. 2001;81(8):1392–1399.
,
Use of prolonged standing for individuals with spinal cord injuries
, Phys Ther.
, vol. 81
(pg. 1392
-1399
) Kaplan PE, Roden W, Gilbert E, Richards L, Goldschmidt JW. Reduction of hypercalciuria in tetraplegia after weight-bearing and strengthening exercises. Paraplegia. 1981;19(5):289–293.
,
Reduction of hypercalciuria in tetraplegia after weight-bearing and strengthening exercises
, Paraplegia.
, vol. 19
(pg. 289
-293
) Kaplan PE, Gandhavadi B, Richards L, Goldschmidt J. Calcium balance in paraplegic patients: influence of injury duration and ambulation. Arch Phys Med Rehabil. 1978;59(10):447–450.
,
Calcium balance in paraplegic patients: influence of injury duration and ambulation
, Arch Phys Med Rehabil.
, vol. 59
(pg. 447
-450
) Kunkel CF, Scremin AM, Eisenberg B, Garcia JF, Roberts S, Martinez S. Effect of “standing” on spasticity, contracture, and osteoporosis in paralyzed males. Arch Phys Med Rehabil. 1993;74(1):73–78.
,
Effect of “standing” on spasticity, contracture, and osteoporosis in paralyzed males
, Arch Phys Med Rehabil.
, vol. 74
(pg. 73
-78
) Mazur JM, Shurtleff D, Menelaus M, Colliver J. Orthopaedic management of high-level spina bifida. Early walking compared with early use of a wheelchair. J Bone Joint Surg Am. 1989;71(1):56–61.
,
Orthopaedic management of high-level spina bifida. Early walking compared with early use of a wheelchair
, J Bone Joint Surg Am.
, vol. 71
(pg. 56
-61
) Rosman N, Spira E. Paraplegic use of walking braces: a survey. Arch Phys Med Rehabil. 1974;55(7):310–314.
,
Paraplegic use of walking braces: a survey
, Arch Phys Med Rehabil.
, vol. 55
(pg. 310
-314
) Sykes L, Edwards J, Powell ES, Ross ER. The reciprocating gait orthosis: long-term usage patterns. Arch Phys Med Rehabil. 1995;76(8):779–783.
,
The reciprocating gait orthosis: long-term usage patterns
, Arch Phys Med Rehabil.
, vol. 76
(pg. 779
-783
) Anderson CJ, Krajci KA, Vogel LC. Life satisfaction in adults with pediatric-onset spinal cord injuries. J Spinal Cord Med. 2002;25(3):184–190.
,
Life satisfaction in adults with pediatric-onset spinal cord injuries
, J Spinal Cord Med.
, vol. 25
(pg. 184
-190
) Dijkers MP. Correlates of life satisfaction among persons with spinal cord injury. Arch Phys Med Rehabil. 1999;80(8):867–876.
,
Correlates of life satisfaction among persons with spinal cord injury
, Arch Phys Med Rehabil.
, vol. 80
(pg. 867
-876
) Fuhrer MJ, Rintala DH, Hart KA, Clearman R, Young ME. Relationship of life satisfaction to impairment, disability, and handicap among persons with spinal cord injury living in the community. Arch Phys Med Rehabil. 1992;73(6):552–557.
,
Relationship of life satisfaction to impairment, disability, and handicap among persons with spinal cord injury living in the community
, Arch Phys Med Rehabil.
, vol. 73
(pg. 552
-557
) Vogel LC, Lubicky JP. Ambulation with parapodia and reciprocating gait orthoses in pediatric spinal cord injury. Dev Med Child Neurol. 1995;37(11):957–964.
,
Ambulation with parapodia and reciprocating gait orthoses in pediatric spinal cord injury
, Dev Med Child Neurol.
, vol. 37
(pg. 957
-964
) Vogel LC, Lubicky JP. Ambulation in children and adolescents with spinal cord injuries. J Pediatr Orthop. 1995;15(4):510–516.
,
Ambulation in children and adolescents with spinal cord injuries
, J Pediatr Orthop.
, vol. 15
(pg. 510
-516
) Bartonek A, Saraste H, Samuelsson L, Skoog M. Ambulation in patients with myelomeningocele: a 12-year follow-up. J Pediatr Orthop. 1999;19(2):202–206.
,
Ambulation in patients with myelomeningocele: a 12-year follow-up
, J Pediatr Orthop.
, vol. 19
(pg. 202
-206
) Guidera KJ, Smith S, Raney E, et al. Use of the reciprocating gait orthosis in myelodysplasia. J Pediatr Orthop. 1993;13(3):341–348.
,
Use of the reciprocating gait orthosis in myelodysplasia
, J Pediatr Orthop.
, vol. 13
(pg. 341
-348
) Jaspers P, Peeraer L, Van PW, Van der Perre G. The use of an advanced reciprocating gait orthosis by paraplegic individuals: a follow-up study. Spinal Cord. 1997;35(9):585–589.
,
The use of an advanced reciprocating gait orthosis by paraplegic individuals: a follow-up study
, Spinal Cord.
, vol. 35
(pg. 585
-589
) Johnston TE, Finson RL, Smith BT, Bonaroti DM, Betz RR, Mulcahey MJ. Functional electrical stimulation for augmented walking in adolescents with incomplete spinal cord injury. J Spinal Cord Med. 2003;26(4):390–400.
,
Functional electrical stimulation for augmented walking in adolescents with incomplete spinal cord injury
, J Spinal Cord Med.
, vol. 26
(pg. 390
-400
) Katz DE, Haideri N, Song K, Wyrick P. Comparative study of conventional hip-knee-ankle-foot orthoses versus reciprocating-gait orthoses for children with high-level paraparesis. J Pediatr Orthop. 1997;17(3):377–386.
,
Comparative study of conventional hip-knee-ankle-foot orthoses versus reciprocating-gait orthoses for children with high-level paraparesis
, J Pediatr Orthop.
, vol. 17
(pg. 377
-386
) Mazur JM, Kyle S. Efficacy of bracing the lower limbs and ambulation training in children with myelomeningocele. Dev Med Child Neurol. 2004;46(5):352–356.
,
Efficacy of bracing the lower limbs and ambulation training in children with myelomeningocele
, Dev Med Child Neurol.
, vol. 46
(pg. 352
-356
) Robb JE, Gordon L, Ferguson D, Dunhill Z, Elton RA, Minns RA. A comparison of hip guidance with reciprocating gait orthoses in children with spinal paraplegia: results of a ten-year prospective study. Eur J Pediatr Surg. 1999;9 (suppl 1):15–18.
,
A comparison of hip guidance with reciprocating gait orthoses in children with spinal paraplegia: results of a ten-year prospective study
, Eur J Pediatr Surg.
, vol. 9
(pg. 15
-18
) Cerny K, Waters R, Hislop H, Perry J. Walking and wheelchair energetics in persons with paraplegia. 1980;60(9):1133–1139.
,
Walking and wheelchair energetics in persons with paraplegia
, vol. 60
(pg. 1133
-1139
) Franceschini M, Baratta S, Zampolini M, Loria D, Lotta S. Reciprocating gait orthoses: a multicenter study of their use by spinal cord injured patients. Arch Phys Med Rehabil. 1997;78(6):582–586.
,
Reciprocating gait orthoses: a multicenter study of their use by spinal cord injured patients
, Arch Phys Med Rehabil.
, vol. 78
(pg. 582
-586
) Merkel KD, Miller NE, Merritt JL. Energy expenditure in patients with low-, mid-, or high-thoracic paraplegia using Scott-Craig knee-ankle-foot orthoses. Mayo Clin Proc. 1985;60(3):165–168.
,
Energy expenditure in patients with low-, mid-, or high-thoracic paraplegia using Scott-Craig knee-ankle-foot orthoses
, Mayo Clin Proc.
, vol. 60
(pg. 165
-168
) Mikelberg R, Reid S. Spinal cord lesions and lower extremity bracing: an overview and follow-up study. Paraplegia. 1981;19(6):379–385.
,
Spinal cord lesions and lower extremity bracing: an overview and follow-up study
, Paraplegia.
, vol. 19
(pg. 379
-385
) Miller NE, Merritt JL, Merkel KD, Westbrook PR. Paraplegic energy expenditure during negotiation of architectural barriers. Arch Phys Med Rehabil.1984;65(12):778–779.
,
Paraplegic energy expenditure during negotiation of architectural barriers
, Arch Phys Med Rehabil.
, vol. 65
(pg. 778
-779
) Waters RL, Adkins R, Yakura J, Vigil D. Prediction of ambulatory performance based on motor scores derived from standards of the American Spinal Injury Association. Arch Phys Med Rehabil. 1994;75(7):756–760.
,
Prediction of ambulatory performance based on motor scores derived from standards of the American Spinal Injury Association
, Arch Phys Med Rehabil.
, vol. 75
(pg. 756
-760
) Scivoletto G, Petrelli A, Lucente LD, et al. One year follow up of spinal cord injury patients using a reciprocating gait orthosis: preliminary report. Spinal Cord. 2000;38(9):555–558.
,
One year follow up of spinal cord injury patients using a reciprocating gait orthosis: preliminary report
, Spinal Cord.
, vol. 38
(pg. 555
-558
) Scivoletto G, Romanelli A, Mariotti A, et al. Clinical factors that affect walking level and performance in chronic spinal cord lesion patients. Spine. 2008;33(3):259–264.
,
Clinical factors that affect walking level and performance in chronic spinal cord lesion patients
, Spine.
, vol. 33
(pg. 259
-264
) Solomonow M, Reisin E, Aguilar E, Baratta RV, Best R, D’Ambrosia R. Reciprocating gait orthosis powered with electrical muscle stimulation (RGO II). Part II: Medical evaluation of 70 paraplegic patients. Orthopedics. 1997;20(5):411–418.
,
Reciprocating gait orthosis powered with electrical muscle stimulation (RGO II). Part II: Medical evaluation of 70 paraplegic patients
, Orthopedics.
, vol. 20
(pg. 411
-418
) Whittle MW, Cochrane GM, Chase AP, et al. A comparative trial of two walking systems for paralysed people. Paraplegia. 1991;29(2):97–102.
,
A comparative trial of two walking systems for paralysed people
, Paraplegia.
, vol. 29
(pg. 97
-102
) Winchester PK, Carollo JJ, Parekh RN, Lutz LM, Aston JW Jr. A comparison of paraplegic gait performance using two types of reciprocating gait orthoses. Prosthet Orthot Int. 1993;17(2):101–106.
,
A comparison of paraplegic gait performance using two types of reciprocating gait orthoses
, Prosthet Orthot Int.
, vol. 17
(pg. 101
-106
) World Health Organization. Towards a Common Language for Functioning, Disability and Health: The International Classification of Functioning, Disability and Health. Geneva: World Health Organization; 2002.
,
Towards a Common Language for Functioning, Disability and Health: The International Classification of Functioning, Disability and Health.
Catz A, Itzkovich M, Agranov E, Ring H, Tamir A. SCIM–Spinal Cord Independence Measure: a new disability scale for patients with spinal cord lesions. Spinal Cord. 1997;35(12):850–856.
,
SCIM–Spinal Cord Independence Measure: a new disability scale for patients with spinal cord lesions
, Spinal Cord.
, vol. 35
(pg. 850
-856
) Catz A, Itzkovich M, Agranov E, Ring H, Tamir A. The Spinal Cord Independence Measure (SCIM): sensitivity to functional changes in subgroups of spinal cord lesion patients. Spinal Cord. 2001;39(2):97–100.
,
The Spinal Cord Independence Measure (SCIM): sensitivity to functional changes in subgroups of spinal cord lesion patients
, Spinal Cord.
, vol. 39
(pg. 97
-100
) Lam T, Noonan VK, Eng JJ. A systematic review of functional ambulation outcome measures in spinal cord injury. Spinal Cord. 2008;46(4):246–254.
,
A systematic review of functional ambulation outcome measures in spinal cord injury
, Spinal Cord.
, vol. 46
(pg. 246
-254
) Kim CM, Eng JJ, Whittaker MW. Level walking and ambulatory capacity in persons with incomplete spinal cord injury: relationship with muscle strength. Spinal Cord. 2004;42(3):156–162.
,
Level walking and ambulatory capacity in persons with incomplete spinal cord injury: relationship with muscle strength
, Spinal Cord.
, vol. 42
(pg. 156
-162
) Dodds TA, Martin DP, Stolov WC, Deyo RA. A validation of the functional independence measurement and its performance among rehabilitation inpatients. Arch Phys Med Rehabil. 1993;74(5):531–536.
,
A validation of the functional independence measurement and its performance among rehabilitation inpatients
, Arch Phys Med Rehabil.
, vol. 74
(pg. 531
-536
) Hall KM, Cohen ME, Wright J, Call M, Werner P. Characteristics of the Functional Independence Measure in traumatic spinal cord injury. Arch Phys Med Rehabil. 1999;80(11):1471–1476.
,
Characteristics of the Functional Independence Measure in traumatic spinal cord injury
, Arch Phys Med Rehabil.
, vol. 80
(pg. 1471
-1476
) Wright J. The FIM. The Center for Outcome Measurement in Brain Injury. http://www.tbims.org/ combi/FIM/index.html. 2000. Accessed November 7, 2012. http://www.tbims.org/
Hoffer MM, Feiwell E, Perry R, Perry J, Bonnett C. Functional ambulation in patients with myelomeningocele. J Bone Joint Surg Am. 1973;55(1):137–148.
,
Functional ambulation in patients with myelomeningocele
, J Bone Joint Surg Am.
, vol. 55
(pg. 137
-148
) Vogel LC, Mendoza MM, Schottler JC, Chlan KM, Anderson CJ. Ambulation in children and youth with spinal cord injuries. J Spinal Cord Med. 2007;30(suppl 1):S158–S164.
,
Ambulation in children and youth with spinal cord injuries
, J Spinal Cord Med.
, vol. 30
(pg. S158
-S164
) Kilgore KL, Hoyen HA, Bryden AM, Hart RL, Keith MW, Peckham PH. An implanted upper-extremity neuroprosthesis using myoelectric control. J Hand Surg Am. 2008;33(4):539–550.
,
An implanted upper-extremity neuroprosthesis using myoelectric control
, J Hand Surg Am.
, vol. 33
(pg. 539
-550
) Mulcahey MJ, Betz RR, Smith BT, Weiss AA, Davis SE. Implanted functional electrical stimulation hand system in adolescents with spinal injuries: an evaluation. Arch Phys Med Rehabil. 1997;78(6):597–607.
,
Implanted functional electrical stimulation hand system in adolescents with spinal injuries: an evaluation
, Arch Phys Med Rehabil.
, vol. 78
(pg. 597
-607
) Mulcahey MJ, Betz RR, Kozin SH, Smith BT, Hutchinson D, Lutz C. Implantation of the Freehand System during initial rehabilitation using minimally invasive techniques. Spinal Cord. 2004;42(3):146–155.
,
Implantation of the Freehand System during initial rehabilitation using minimally invasive techniques
, Spinal Cord.
, vol. 42
(pg. 146
-155
) Mulcahey M, Calhoun C, Riley A, Haley S. Children’s and parents’ perspectives about activity performance and participation following spinal cord injury, themes from a cognitive interview study. Am J Occup Ther. 2010;64(4):605–613.
,
Children’s and parents’ perspectives about activity performance and participation following spinal cord injury, themes from a cognitive interview study
, Am J Occup Ther.
, vol. 64
(pg. 605
-613
) Chafetz RS, Vogel LC, Betz RR, Gaughan JP, Mulcahey MJ. International Standards for Neurological Classification of Spinal Cord Injury: training effect on accurate classification. J Spinal Cord Med. 2008;31(5):538–542.
,
International Standards for Neurological Classification of Spinal Cord Injury: training effect on accurate classification
, J Spinal Cord Med.
, vol. 31
(pg. 538
-542
) Chafetz RS, Gaughan JP, Vogel LC, Betz R, Mulcahey MJ. The International Standards for Neurological Classification of Spinal Cord Injury: intra-rater agreement of total motor and sensory scores in the pediatric population. J Spinal Cord Med. 2009;32(2):157–161.
,
The International Standards for Neurological Classification of Spinal Cord Injury: intra-rater agreement of total motor and sensory scores in the pediatric population
, J Spinal Cord Med.
, vol. 32
(pg. 157
-161
) Vogel L, Samdani A, Chafetz R, Gaughan J, Betz R, Mulcahey MJ. Intra-rater agreement of the anorectal exam and classification of injury severity in children with spinal cord injury. Spinal Cord. 2009;47(9):687–691.
,
Intra-rater agreement of the anorectal exam and classification of injury severity in children with spinal cord injury
, Spinal Cord.
, vol. 47
(pg. 687
-691
) Burns SP, Golding DG, Rolle WA Jr, Graziani V, Ditunno JF Jr. Recovery of ambulation in motor-incomplete tetraplegia. Arch Phys Med Rehabil. 1997;78(11):1169–1172.
,
Recovery of ambulation in motor-incomplete tetraplegia
, Arch Phys Med Rehabil.
, vol. 78
(pg. 1169
-1172
) Coleman WP, Geisler FH. Injury severity as primary predictor of outcome in acute spinal cord injury: retrospective results from a large multicenter clinical trial. Spine J. 2004;4(4):373–378.
,
Injury severity as primary predictor of outcome in acute spinal cord injury: retrospective results from a large multicenter clinical trial
, Spine J.
, vol. 4
(pg. 373
-378
) Crozier KS, Cheng LL, Graziani V, Zorn G, Herbison G, Ditunno JF Jr. Spinal cord injury: prognosis for ambulation based on quadriceps recovery. Paraplegia. 1992;30(11):762–767.
,
Spinal cord injury: prognosis for ambulation based on quadriceps recovery
, Paraplegia.
, vol. 30
(pg. 762
-767
) Hussey RW, Stauffer ES. Spinal cord injury: requirements for ambulation. Arch Phys Med Rehabil. 1973;54(12):544–547.
,
Spinal cord injury: requirements for ambulation
, Arch Phys Med Rehabil.
, vol. 54
(pg. 544
-547
) van Middendorp JJ, Hosman AJ, Pouw MH, Van de Meent H. ASIA impairment scale conversion in traumatic SCI: Is it related with the ability to walk? A descriptive comparison with functional ambulation outcome measures in 273 patients. Spinal Cord. 2009;47(7):555–560.
,
ASIA impairment scale conversion in traumatic SCI: Is it related with the ability to walk? A descriptive comparison with functional ambulation outcome measures in 273 patients
, Spinal Cord.
, vol. 47
(pg. 555
-560
) van Middendorp JJ, Hosman AJ, Pouw MH, Van de Meent H. Is determination between complete and incomplete traumatic spinal cord injury clinically relevant? Validation of the ASIA sacral sparing criteria in a prospective cohort of 432 patients. Spinal Cord. 2009;47(11):809–816.
,
Is determination between complete and incomplete traumatic spinal cord injury clinically relevant? Validation of the ASIA sacral sparing criteria in a prospective cohort of 432 patients
, Spinal Cord.
, vol. 47
(pg. 809
-816
) Samdani A, Chafetz RS, Vogel LC, Betz RR, Gaughan JP, Mulcahey MJ. The International Standards for Neurological Classification of Spinal Cord Injury: relationship between S4-5 dermatone testing and anorectal testing. Spinal Cord. 2011;49(3):352–356.
,
The International Standards for Neurological Classification of Spinal Cord Injury: relationship between S4-5 dermatone testing and anorectal testing
, Spinal Cord.
, vol. 49
(pg. 352
-356
) Eaton DK, Kann L, Kinchen S, et al. Youth risk behavior surveillance–United States, 2007. MMWR Surveill Summ. 2008; 57(4):1–131.
,
Youth risk behavior surveillance–United States
, MMWR Surveill Summ.
, vol. 57
(pg. 1
-131
)
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