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

Tita, Anne C. MD; Frampton, John R. MD; Roehmer, Christian BA; Izzo, Sara E.; Houtrow, Amy J. MD, PhD, MPH; Dicianno, Brad E. MD

American Journal of Physical Medicine & Rehabilitation: December 2019 - Volume 98 - Issue 12 - p 1045–1050
doi: 10.1097/PHM.0000000000001188
Original Research Articles: CME Article . 2019 Series . Number 12

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

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.

From the Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (ACT, JRF, CR, SEI, AJH, BED); Department of Rehabilitation Science and Technology, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania (BED); and Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania (BED).

All correspondence should be addressed to: Brad E. Dicianno, MD, Human Engineering Research Laboratories, Bakery Square, 6425 Penn Ave, Suite 400, Pittsburgh, PA 15206.

This study was supported by the National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia (Grant Number U01DD001078). The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Data from this article were accepted as part of an abstract and were presented at the 2017 Association for Academic Physiatrists Annual Meeting in Las Vegas, Nevada on February 9, 2017.

Christian Roehmer is in training.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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Online date: April 1, 2019

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