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

*Corresponding author for this work

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)
Pages (from-to)215-223
Number of pages9
JournalArchives of physical medicine and rehabilitation
Issue number2
StatePublished - Feb 2022


  • 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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