Treatment Characteristics and Outcomes in 58 Children with Spinal Cord Injury

Background: Spinal cord injury (SCI) can change an individual’s life significantly and usually irreversibly. Recently, the incidence of spinal SCI in children has shown an upward trend. Many of them arise from back bends in dances. SCI can cause great suffering and dysfunction to children because they are still in the physical development stage and the degree of injury and prognosis are different from adults. This study aimed to analyze the characteristics of children with SCI and their prognosis, to study the causes of these injuries, and to explore rehabilitation strategies for children with SCI. Methods: The clinical data of children with SCI, including general conditions, cause and degree of injury, and effects of rehabilitation were analyzed and evaluated. Results: Out of the 58 patients, 22 (37.93%) had SCI at and above T6, 34 (58.62%) at T7-T12, and 2 (3.45%) at and below L1. The injuries were caused by a back bend in 35 cases (60.34%) and by traffic accidents in eight cases (13.79%). Upon discharge, seven patients (12.07%) achieved independent walking ability, 33 (56.90%) realized wheelchair independence, and 46 (79.31%) attained basic or complete self-care ability. Fifty-six (96.55%) of these children with SCI experienced bladder dysfunction, 55 (94.83%) experienced rectal dysfunction, and 20 (34.48%) had scoliosis. Conclusions: Children with incomplete SCI are able to gain a great degree of functional recovery while children with complete SCI can achieve better independent living ability through active comprehensive rehabilitation training.

Conclusions: Children with incomplete SCI are able to gain a great degree of functional recovery while children with complete SCI can achieve better independent living ability through active comprehensive rehabilitation training. 3 Background Spinal cord injury (SCI) is rare, and cases in children account for 2-5% of all SCI occurrences [1][2][3][4][5][6]. In recent years, the incidences of SCI in children has had an upward trend. Thirty patients have been admitted and treated in our hospital. SCI differs in children and adults in terms of incidence, type and site of injury, and prognosis. This paper reviewed 58 children with SCI admitted, treated, and investigated in the past few years to analyze therapeutic characteristics and efficacy.

Subjects
Fifty-eight children with SCI, 6 males and 52 females, were included in this study.

Case sources
The patients were divided into admittance and treatment group (n = 30) and investigation group (n = 28). Clinical data, including sex, age, cause of injury, injury level, degree of injury, and rehabilitation of the children with SCI admitted and 4 treated in our hospital from January 2004 to January 2017 were reviewed.

Clinical evaluation
The level and degree of SCI were determined according to the International Standards for Neurological Classification of Spinal Cord Injury formulated by the American Spinal Injury Association (ASIA) in 1982 [6]. Patients were divided into three groups based on the site of injury: T6 and above, T7-T12, and L1 and below.

Rehabilitation evaluation
Rehabilitation evaluation must be carried out prior to rehabilitation treatment.
Discharge evaluation included walking capacity (including walking by wearing a brace), wheelchair capacity, and self-care ability. Wheelchair capacity was further divided into wheelchair independence and wheelchair dependence. Patients were considered to have basic wheelchair independence if they are able to push their wheelchair for 50 meters on flat ground and perform bed to wheelchair transfer on their own. Self-care ability was evaluated using a modified Barthel Index, where a score >60 points is considered complete self-care; 40-60 points, partial self-care; and <40 points, living dependence.

Rehabilitation treatment
Physical therapy included passive movements, static stretching, position changing,

Rehabilitation nursing
Patients and family members received training on turning over and positioning, pressure sore management, bladder management including clean intermittent catheterization and drinking/urination planning, and rectum management including dietary structural adjustment and anus stretching.

Results
The SCI levels of the 58 patients were mostly in the thoracic region, with 22 cases (37.93%) at T6 level and above and 34 cases (58.62%) at T7-T12 level. This is contrary to injuries in adults, which commonly occur in the thoracolumbar region [7,8]. Forty-seven cases (81.03%) had complete injury ( Table 1). The primary cause of injury was back bend in 35 cases (60.34%) and traffic accidents in eight cases (13.79%) ( Table 2).

Analysis of injury
In our patients, over 60% of the injuries were caused by a back bend, which must be Based on these eight anatomical and physiological characteristics, children are subject to SCI without radiographic abnormalities (SCIWORA) in carrying out lower back activities. SCIWORA was first proposed by Pang in 1982 [9]. Its incidence in children is markedly higher than in adults, and most are complete injuries with poor recovery [5]. Therefore, sufficient preparations should be carried out prior to lower back dancing movements in children. Lower back training should be performed step by step, rather than in a rush for quick results.

Prognosis
The prognosis is mainly related to the degree of primary SCI after trauma. Early These patients were contacted by telephone to obtain verbal informed consent.

Consent for publication
Not applicable.

Availability of data and materials
The datasets used and/or analyzed during the current study are available from the corresponding author on a validated request.

Competing interests
The authors declare that they have no competing interests.

Funding
Funding for this study was received from a key program of the Science and