Correlation Between Neurologic Impairment Grade and Ambulation Status in the Adult Spina Bifida Population

Abstract

Objective: The aim of the study was to identify which neurologic impairment scales correlate with ambulation status in adults with spina bifida.

Design: A retrospective chart review was performed on patients seen at the University of Pittsburgh Medical Center Adult Spina Bifida Clinic. Findings were graded using several neurologic impairment scales: two versions of the National Spina Bifida Patient Registry classification, the International Standards for Neurological Classification of Spinal Cord Injury motor level, and the Broughton Neurologic Impairment Scale. Ambulation ability was ranked using the Hoffer classification system.

Results: Data collected from 409 patient records showed significant correlations between Hoffer ambulation status and all neurologic impairment scales evaluated. The strongest correlation was noted with the Broughton classification (rs = -0.771, P < 0.001). High correlations were also noted with both versions of the National Spina Bifida Patient Registry: strength 3/5 or greater (rs = -0.763, P < 0.001), and strength 1/5 or greater (rs = -0.716, P < 0.001). For the International Standards for Neurological Classification of Spinal Cord Injury motor level, only a moderate correlation was observed (rs = -0.565, P < 0.001).

Conclusions: Multiple grading scales can be used to measure motor function in adult spina bifida patients. Although the Broughton classification seems to be the most highly correlated with ambulation status, the less complex National Spina Bifida Patient Registry scale is also highly correlated and may be easier to administer in busy clinic settings.

To claim cme credits: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Explain the clinical significance of identifying ambulation status and maximizing ambulation potential in adults with spina bifida; (2) Describe each of the neurologic grading scales examined in this study, identifying potential shortcomings in applying them to the adult spina bifida population; and (3) Administer the National Spina Bifida Patient Registry (NSBPR) impairment scale motor assessment in a standard adult spina bifida outpatient clinic visit.

Level: Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

FIGURE 1.

Relationship of Hoffer ambulatory status to Broughton scale. Legend: Hoffer ambulation status rated 1–4 (community ambulation, household ambulation, therapeutic/nonfunctional ambulation, lack of ambulation) compared with Broughton classification rated 0–8 (thoracic, L1, L2, L3, L4, L5, S1, S2, no loss) using Spearman’s ρ testing.

FIGURE 2.

Relationship of Hoffer ambulatory status to NSBPR scale ≥ 3/5. Legend: Hoffer ambulation status rated 1–4 (community ambulation, household ambulation, therapeutic/nonfunctional ambulation, lack of ambulation) compared with the NSBPR scale with muscle strength of 3/5 or greater rated 0–4 (thoracic, high-lumbar, mid-lumbar, low-lumbar, sacral) using Spearman’s ρ testing.

FIGURE 3.

Relationship of Hoffer ambulatory status to NSBPR scale ≥ 1/5. Legend: Hoffer ambulation status rated 1–4 (community ambulation, household ambulation, therapeutic/nonfunctional ambulation, lack of ambulation) compared with the NSBPR scale with muscle strength of 1/5 or greater rated 0–4 (thoracic, high-lumbar, mid-lumbar, low-lumbar, sacral) using Spearman’s ρ testing.

FIGURE 4.

Relationship of Hoffer ambulatory status to ISNCSCI scale. Legend: Hoffer ambulation status rated 1–4 (community ambulation, household ambulation, therapeutic/nonfunctional ambulation, lack of ambulation) compared to the ISNCSCI scale rated 2–28 (C2 through S4-S5) using Spearman’s ρ testing.