{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:01:06Z","timestamp":1792598466165,"version":"4.5.0"},"reference-count":47,"publisher":"SAGE Publications","issue":"9-10","license":[{"start":{"date-parts":[[2024,5,1]],"date-time":"2024-05-01T00:00:00Z","timestamp":1714521600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neurotrauma"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:p>\n                    Cervical spinal cord injury (SCI) causes devastating loss of upper limb function and independence. Restoration of upper limb function can have a profound impact on independence and quality of life. In low-cervical SCI (level C5\u2013C8), upper limb function can be restored via reinnervation strategies such as nerve transfer surgery. The translation of recovered upper limb motor function into functional independence in activities of daily living (ADLs), however, remains unknown in low cervical SCI (i.e., tetraplegia). The objective of this study was to evaluate the association of patterns in upper limb motor recovery with functional independence in ADLs. This will then inform prioritization of reinnervation strategies focused to maximize function in patients with tetraplegia. This retrospective study performed a secondary analysis of patients with low cervical (C5\u2013C8) enrolled in the SCI Model Systems (SCIMS) database. Baseline neurological examinations and their association with functional independence in major ADLs\u2014i.e., eating, bladder management, and transfers (bed\/wheelchair\/chair)\u2014were evaluated. Motor functional recovery was defined as achieving motor strength, in modified research council (MRC) grade, of \u2265\u20093\u2009\/5 at one year from \u2264\u20092\/5 at baseline. The association of motor function recovery with functional independence at one-year follow-up was compared in patients with recovered elbow flexion (C5), wrist extension (C6), elbow extension (C7), and finger flexion (C8). A multi-variable logistic regression analysis, adjusting for known factors influencing recovery after SCI, was performed to evaluate the impact of motor function at one year on a composite outcome of functional independence in major ADLs. Composite outcome was defined as functional independence measure score of 6 or higher (complete independence) in at least two domains among eating, bladder management, and transfers. Between 1992 and 2016, 1090 patients with low cervical SCI and complete neurological\/functional measures were included. At baseline, 67% of patients had complete SCI and 33% had incomplete SCI. The majority of patients were dependent in eating, bladder management, and transfers. At one-year follow-up, the largest proportion of patients who recovered motor function in finger flexion (C8) and elbow extension (C7) gained independence in eating, bladder management, and transfers. In multi-variable analysis, patients who had recovered finger flexion (C8) or elbow extension (C7) had higher odds of gaining independence in a composite of major ADLs (odds ratio [OR]\u2009=\u20093.13 and OR\u2009=\u20092.87, respectively,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Age 60 years (OR\u2009=\u20090.44,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.01), and complete SCI (OR\u2009=\u20090.43,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.002) were associated with reduced odds of gaining independence in ADLs. After cervical SCI, finger flexion (C8) and elbow extension (C7) recovery translate into greater independence in eating, bladder management, and transfers. These results can be used to design individualized reinnervation plans to reanimate upper limb function and maximize independence in patients with low cervical SCI.\n                  <\/jats:p>","DOI":"10.1089\/neu.2023.0140","type":"journal-article","created":{"date-parts":[[2023,12,8]],"date-time":"2023-12-08T02:41:01Z","timestamp":1702003261000},"page":"1211-1222","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["Impact of Upper Limb Motor Recovery on Functional Independence After Traumatic Low Cervical Spinal Cord Injury"],"prefix":"10.1177","volume":"41","author":[{"given":"Saad","family":"Javeed","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Washington University, St. Louis, Missouri, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin K.","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Utah, Salt Lake City, Utah, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob K.","family":"Greenberg","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Washington University, St. Louis, Missouri, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Botterbush","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Washington University, St. Louis, Missouri, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Braeden","family":"Benedict","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Washington University, St. Louis, Missouri, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Plog","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Washington University, St. Louis, Missouri, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivek P.","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Washington University, St. Louis, Missouri, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher F.","family":"Dibble","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Washington University, St. Louis, Missouri, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jawad M.","family":"Khalifeh","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Johns Hopkins University, Baltimore, Maryland, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huacong","family":"Wen","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuying","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yikyung","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Public Health Sciences, Department of Surgery, Washington University, St. Louis, Missouri, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan","family":"Belzberg","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Johns Hopkins University, Baltimore, Maryland, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sami","family":"Tuffaha","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen Shelby","family":"Burks","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan D.","family":"Levi","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric L.","family":"Zager","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir H.","family":"Faraji","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A.","family":"Mahan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Utah, Salt Lake City, Utah, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajiv","family":"Midha","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas J.","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University, Palo Alto, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neringa","family":"Juknis","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation, Washington University, St. Louis, Missouri, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilson Z.","family":"Ray","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Washington University, St. Louis, Missouri, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Nerve Transfers in Spinal Cord Injury (NT-SCI) Consortium","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,5,25]]},"reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.6250"},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","DOI":"10.1038\/sc.2012.158"},{"key":"e_1_3_7_4_2","doi-asserted-by":"publisher","DOI":"10.2147\/clep.s68889"},{"key":"e_1_3_7_5_2","unstructured":"Spinal Cord Injury Facts and Figures at a Glance. 2020. 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