Walking Outcome After Traumatic Paraplegic Spinal Cord Injury: The Function of Which Myotomes Makes a Difference?
Adrian Cathomen, Doris Maier, Jiri Kriz and 10 others
PMID 37039327WHAT IT FOUND
Early hip flexion and knee extension strength on the weaker leg predicts whether a person with paraplegic SCI will walk at six months.
Distal leg strength determines if they can walk outdoors. These simple bedside tests help set realistic recovery expectations and guide rehab intensity.
Key findings
01Patients with hip flexion (L2) or knee extension (L3) motor scores of 1 or higher on the more impaired leg within 15 days of injury had high rates of walking recovery (85% and 88%, respectively).
02Distal myotomes (L4-S1) on the more impaired leg differentiated between indoor walkers and those able to walk outdoors, with higher scores predicting outdoor ambulation.
03The stratification model identified Lower Extremity Motor Score (LEMS), Light Touch (LT), age, and Pin Prick (PP) as the strongest predictors of walking function at six months.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Selection bias: The study group required complete data at 15 days and 6 months, resulting in a higher proportion of severe injuries (AIS A) compared to the full database, though baseline scores within severity groups were similar. The model did not account for secondary complications or specific therapy interventions, which can influence recovery. The stratification model failed to reliably distinguish walkers from non-walkers in two specific intermediate nodes (5 and 6), indicating that current assessments may not capture all recovery drivers. Patients with tetraplegia were excluded to avoid bias from upper extremity impairment affecting walking aid use.
Declared interests
No conflicts of interest declared. Funding from Wings for Life foundation and International Foundation for Research in Paraplegia. Funders had no role in study design, data collection, analysis, or manuscript writing.
The easy way to misread this
Do not interpret the high percentage of walkers among those with L2/L3 scores of 1+ as a guarantee of functional independence. The study shows a strong association with the ability to walk (ambulation), but distal muscle function (L4-S1) is the key differentiator for outdoor walking versus indoor-only walking. A patient may walk indoors but remain wheelchair-dependent outdoors if distal strength is absent.