Physical Function Recovery Trajectories After Spinal Cord Injury

David S. Tulsky, Aaron J. Boulton, Pamela A. Kisala, Allen W. Heinemann, Susan Charlifue, Claire Z. Kalpakjian, Allan J. Kozlowski, Elizabeth R. Felix, Denise C. Fyffe, Mary D. Slavin, Denise G. Tate

Research output: Contribution to journalArticlepeer-review


Objective: To explore trajectories of functional recovery that occur during the first 2 years after spinal cord injury (SCI). Design: Observational cohort study. Setting: Eight SCI Model System sites. Participants: A total of 479 adults with SCI completed 4 Spinal Cord Injury-Functional Index (SCI-FI) item banks within 4 months of injury and again at 2 weeks, 3, 6, 12, and 24 months after baseline assessment (N=479). Intervention: None. Main Outcome Measures: SCI-FI Basic Mobility/Capacity (C), Fine Motor Function/C, Self-care/C, and Wheelchair Mobility/Assistive Technology (AT) item banks. Results: Growth mixture modeling was used to identify groups with similar trajectory patterns. For the Basic Mobility/C and Wheelchair Mobility/AT domains, models specifying 2 trajectory groups were selected. For both domains, a majority class exhibited average functional levels and gradual improvement, primarily in the first 6 months. A smaller group of individuals made gradual improvements but had greater initial functional limitations. The Self Care/C domain exhibited a similar pattern; however, a third, small class emerged that exhibited substantial improvement in the first 6 months. Finally, for individuals with tetraplegia, trajectories of Fine Motor Function/C scores followed 2 patterns, with individuals reporting generally low initial scores and then making either modest or large improvements. In individual growth curve models, injury/demographic factors predicted initial functional levels but less so regarding rates of recovery. Conclusions: Trajectories of functional recovery followed a small number of change patterns, although variation around these patterns emerged. During the first 2 years after initial hospitalization, SCI-FI scores showed modest improvements; however, substantial improvements were noted for a small number of individuals with severe limitations in fine motor and self-care function. Future studies should further explore the personal, medical, and environmental characteristics that influence functional trajectories during these first 2 years and beyond.

Original languageEnglish (US)
JournalArchives of physical medicine and rehabilitation
StateAccepted/In press - 2021


  • Mobility
  • Mobility limitation
  • Outcomes assessment (healthcare)
  • Recovery of Function
  • Rehabilitation
  • Self Care
  • Spinal cord injuries

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation


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