Before designing and applying a self-management program, we need to know whether our program will fit all patients or whether different components must be added for different segments of our targeted population. This information is important when we tailor programs to meet the needs of specific groups within the population we are teaching self-management skills. McKinley and coworkers did such an analysis by examining and comparing demographic and functional outcomes for individuals with spinal cord injury clinical syndromes, including central cord, Brown-Sequard, anterior cord, posterior cord, cauda equina, and conus medullaris. The prospective study was a retrospective review of eight hundred thirty-nine consecutive admissions with acute spinal cord injury treated at a tertiary care unit. The outcome measures were functional independence, functional independence subgroups (motor, self-care, sphincter control), length of stay, and discharge disposition. One hundred seventy-five patients were diagnosed with spinal cord clinical syndromes, with central cord injury the most common followed by cauda equina and Brown-Sequard. Significant differences were found between groups with regard to age, race, etiology, total admission functional independence, motor admission functional independence, self-care admission and discharge functional independence, and length of stay.

VALUE OF STUDY TO READER: Spinal cord clinical syndromes represent a significant proportion of admissions to acute rehabilitation, with central cord injuries presenting most commonly and representing the oldest age group with the lowest admission functional level of all spinal cord clinical syndromes. Patients with cervical Brown-Sequard achieved higher functional improvement by discharge compared with patients with central cord injury. The authors outlined these and other differences among subgroups. These differences are undoubtedly important for those who rehabilitate these patients. However, the knowledge is also significant when it comes to designing a self-management program for spinal cord injury patients. A general program would be effective, particularly if augmented with training targeted at specific subgroups of spinal cord injury patients.

McKinley W, Santos K, Meade M, Brooke K. Incidence and outcomes of spinal cord injury clinical syndromes. Journal Spinal Cord Medicine, 2007;30:215-24.