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

Tita, Anne C., MD1; Frampton, John R., MD1; Roehmer, Christian, BA1; Izzo, Sara E.1; Houtrow, Amy J., MD, PhD, MPH1; Dicianno, Brad E., MD1,3

American Journal of Physical Medicine & Rehabilitation: March 29, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHM.0000000000001188
Research Article: PDF Only

Objective This study’s purpose 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 UPMC Adult Spina Bifida Clinic. Findings were graded using several neurologic impairment scales: two versions of the National Spina Bifida Patient Registry (NSBPR) classification, the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) 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 and p<0.001). High correlations were also noted with both versions of NSBPR: strength 3/5 or greater (rs=-0.763 and p<0.001), and strength 1/5 or greater (rs=-0.716 and p<0.001). For ISNCSCI motor level, only a moderate correlation was observed (rs=-0.565 and p<0.001).

Conclusions Multiple grading scales can be used to measure motor function in adult spina bifida patients. While the Broughton classification appears to be the most highly correlated with ambulation status, the less complex NSBPR scale is also highly correlated and may be easier to administer in busy clinic settings.

1Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA

2Department of Rehabilitation Science and Technology, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, PA

3Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA

Correspondence should be directed to: Brad E. Dicianno, MD Human Engineering Research Laboratories Bakery Square, 6425 Penn Avenue, Suite 400 Pittsburgh, PA 15206 (

Disclosures: This manuscript has not been published and is not under consideration for publication elsewhere. Data from this manuscript was accepted as part of an abstract and was presented at the 2017 Association for Academic Physiatrists Annual Meeting in Las Vegas, Nevada. This project was funded by the National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, Grant # 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. 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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