The Investigation On Patient’s Upper Limb Function Evaluation And Rehabilitation Treatment After Upper Cervical Spinal Cord Injury Underlying ICF Concept

Objective In the present investigation,we would carry out the systematic evaluation,optimized treatment,as well as rehabilitation programs for patients with spinal cord injury（SCI）in the upper cervical segment（C1-C4）,via observing the recovery of upper limb function.We aim to establish a rehabilitation intervention model for upper limb function in patients with upper and lower limb paralysis caused by SCI in the upper cervical segment.Methods From January 2018 to December 2019,52 patients with upper limb dysfunction caused by upper spine SCI were included.They all accepted a cervical spine surgery in the Department of Orthopedics of the First Affiliated Hospital of Guangxi Medical University,and then were transferred to the Rehabilitation Department of Rehabilitation Medicine of our hospital.They were divided into two groups according to random number table,26 patients for each group.In the control group,conventional spinal cord injury classification（AIS classification）and Modified barthel index scale,anxiety scale,quality of life assessment and routine rehabilitation treatment were all carried out.In the observation group,the ICF assessment combined with AIS classification assessment and Modified barthel index scale,anxiety scale,quality of life table evaluation method were all carried out to comprehensively evaluate the functional status of patients with SCI in the upper cervical segment.The effective and optimized rehabilitation treatment and supervise the implementation and follow-up,regularly assess the functional status of the patient were also performed.An adjustment of rehabilitation plan and strategy was in real time if necessary.Results Before rehabilitation treatment,upper limb muscle strength,muscle tone and sensory（acupuncture,light touch）function,activities of daily living（ADL）scores,vital capacity（VC）,maximum ventilation（MVV）,forced expiratory volume in 1 second（FEV₁）)Compared with other lung function indexes,Hamilton Anxiety Scale（HAMA）scores and WHOQOL-BREF scale scores,the difference was not statistically significant between these two groups（all P>0.05）.4 weeks after rehabilitation intervention and 8 weeks after discharge,compared with the group,the upper limb muscle strength,muscle tension,sensory（acupuncture,light touch）function,ADL other scores and MVV indicators,HAMA scores and WHOQOL-BREF’s psychological and social scores were improved compared with before treatment,and 8 weeks after rehabilitation intervention,the scores were higher than 4 weeks,and the differences were statistically significant（all P<0.05）;at 4 and 8 weeks after treatment,the FEV₁ indicators were higher than before treatment,the VC index was higher at 8 weeks after treatment than before treatment,and at 4 weeks after treatment,and the differences were statistically significant（all P<0.05）.comparison between groups,observation group upper limb muscle strength and the scores obtained by ADL indicators were higher than those of the control group,and the psychological scores of WHOQOL-BREF and the social and environmental scores at 8 weeks after discharging were higher than those of the control group.The muscle tension score,HAMA score were lower than those of the control group,and the differences were statistically significant（all P<0.05）,and the incidence of complications was lower than the control group,and there were no statistically significant differences in sensory scores and lung function index scores between the two groups（all P>0.05）.Conclusion Compared with the control group who only used of AIS impairment classification,Modified barthel index assessment,etc and conventional rehabilitation methods to treat patients,the combined use of the ICF-based assessment and rehabilitation treatment table in the observation group can reflect the body function,activity and participation ability more comprehensively and accurately of patients with upper cervical spinal cord injury.It could improve patients’upper limb motor function and daily living ability effectively,reduce anxiety,and reduce the occurrence of complications and improve their quality of life,There were little differences improvement between the two groups in lung function and upper limb sensory function.