AA

Functional Independence

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Motor and sensory impairments after spinal cord injury cause a variety of functional impairments. Functional impairments are defined as restrictions that hinder an individual’s ability to perform tasks or activities (Jette 2006). Functional tasks are often described in terms of basic activities of daily living such as walking, climbing stairs, bathing and grooming. With complete lesions, higher levels of injury cause greater motor and sensory impairment, which are associated with greater functional impairments (Aidinoff et al. 2011).  Incomplete lesions produce a more complicated pattern of motor and sensory impairments (Yilmaz et al. 2005). Individuals who have problems performing functional tasks frequently rely on a combination of assistive devices and assistance from others. Haisma et al. (2008) found that functional motor independence improved during in-patient rehabilitation and remained relatively stable one year post-discharge. Given that functional independence is a strong, significant predictor of care needs over time (Cohen et al. 2012), it is extremely important to understand the long-term functional independence of individuals with spinal cord injury.

In this section, 1 systematic review (see Table 12) and 5 longitudinal studies (see Table 13) on functional independence after SCI are reviewed.

Table 12: Systematic Review on Functional Independence

In this systematic review, the authors report thatmotor and functional recovery decreases with advancing age for complete SCI. They also report no association between recovery and age for individuals with incomplete SCIs. Only three studies were included in this review that examined the association with age. This may indicate a dearth of evidence on the impact of aging on functional independence, and that the results should be interpreted with caution.

Table 13: Aging and Functional Independence

Discussion

All the studies report some decline in functional independence over time, although interestingly, Amsters et al. (2005) found that individuals with SCI perceived functional improvements in the first 10 years post-injury and then a subsequent decline. This study suffers from recall bias as individuals were asked to recount their function from up to 10 years post-injury.

Conclusions

There is level 4 evidence from one retrospective longitudinal study (Pershouse et al. 2012) that functional independence decreases with more years post injury for individuals who were higher functioning at one year.

There is Level 4 evidence from one longitudinal study (Amsters et al. 2005) that individuals with SCI (³20 YPI) perceive functional improvements up to 10 YPI and subsequent functional decline and greater dependence on mobility aids after 10 or more YPI.  

  • Functional independence decreases with more years post injury.