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This study aimed to model the trajectory of recovery after SCI and define distinct post-injury phases based on real-world clinical data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed longitudinal data from 4407 individuals with traumatic SCI enrolled in the European Multicenter Study about Spinal Cord Injury (EMSCI). Neurological improvement was quantified using the Integrated Neurological Change Score (INCS). Functional recovery was assessed using the Spinal Cord Independence Measure (SCIM) and a derived measure of hand motor function based on motor scores of the C6, C8, and T1 myotomes. Longitudinal recovery trajectories were modeled using random forest regression, locally estimated scatterplot smoothing (LOESS), and neural networks. Lastly, latent class mixed models (LCMM) were employed to identify subgroups with distinct recovery profiles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Across all models, neurological recovery followed a four-stage sigmoidal pattern: an acute phase (up to \u223c2 weeks post-injury) with minimal change; a transition phase (\u223c2 to 9\u201311 weeks) marked by substantial neurological change; a pre-chronic phase (\u223c10 weeks to 7\u20138 months) characterized by ongoing but non-linear recovery; and a chronic phase (beyond \u223c7\u20138 months) in which recovery plateaued. Neurological improvement consistently preceded functional gains captured by SCIM and hand motor strength. Latent class analysis identified four distinct recovery profiles: class 1 (marked recovery), classes 2 and 3 (moderate recovery), and class 4 (minimal to no recovery). Notably, despite significant variability in the magnitude of lower extremity recovery across classes, the timing of the transition phase was remarkably consistent, aligning with the population-level window of approximately 10\u201311 weeks post-injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The majority of neurological and functional improvement occurs within the first \u223c10 weeks post-injury. These findings align with the concept of a period of heightened neuroplasticity and provide a data-driven framework for timing assessments and interventions in SCI recovery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00415-026-14065-9","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T14:37:52Z","timestamp":1787150272000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A data-driven approach to define the stages and patterns of neurological recovery after traumatic spinal cord injury"],"prefix":"10.1007","volume":"273","author":[{"given":"Wanda","family":"Lauth","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abel","family":"Torres-Espin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angel","family":"Arevalo-Martin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Garcia-Ovejero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orpheus","family":"Mach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doris","family":"Maier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rainer","family":"Abel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norbert","family":"Weidner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yorck-Bernhard","family":"Kalke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiri","family":"Kriz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armin","family":"Curt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"EMSCI Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Jutzeler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5963-0598","authenticated-orcid":false,"given":"Iris","family":"Leister","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"issue":"Suppl1","key":"14065_CR1","doi-asserted-by":"publisher","first-page":"11","DOI":"10.3171\/2012.4.AOSPINE1245","volume":"17","author":"JR Wilson","year":"2012","unstructured":"Wilson JR, Cadotte DW, Fehlings MG (2012) Clinical predictors of neurological outcome, functional status, and survival after traumatic spinal cord injury: a systematic review. 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Sci Rep 14(1):1294. https:\/\/doi.org\/10.1038\/s41598-024-51474-0","journal-title":"Sci Rep"}],"container-title":["Journal of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00415-026-14065-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00415-026-14065-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00415-026-14065-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T06:17:13Z","timestamp":1789021033000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00415-026-14065-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,19]]},"references-count":38,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["14065"],"URL":"https:\/\/doi.org\/10.1007\/s00415-026-14065-9","relation":{},"ISSN":["0340-5354","1432-1459"],"issn-type":[{"value":"0340-5354","type":"print"},{"value":"1432-1459","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,19]]},"assertion":[{"value":"10 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 July 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 August 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 August 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare that there is no conflict of interest.","order":1,"name":"Ethics","label":"Conflicts of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All study-related data exports, transfer, and analysis were in accordance with the 1964 Declaration of Helsinki and its later amendments, the EU 2016\/679 GDPR (General Data Protection Regulation), and the BDSG (Bundesdatenschutzgesetz) federal legal regulations in Germany. All individuals provided written informed consent permitting the use of their medical data for research purposes as part of their participation in the European Multicenter Study about Spinal Cord Injury (EMSCI) registry. The EMSCI has been approved by the Ethics Committee of the University of Heidelberg (Vote no. S-188\/2003, Amendment 9).","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors acknowledge the use of large language models (ChaptGPT) to support the drafting of text within this article. Any suggestions obtained were critically reviewed and rephrased where needed. The authors emphasize that support was limited to grammatical and editorial phrasing. The authors take full responsibility for the content of the publication.","order":3,"name":"Ethics","label":"Generative AI and AI-assisted technologies","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"531"}}