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Background The effects of multiple injuries on the neurological and functional outcomes of patients with traumatic spinal cord injury (SCI) are debated—some groups have shown that subjects with multiple injuries have the same neurological and functional outcomes of those without them, whereas others have found that SCI patients with associated traumatic brain injury have worse functional status at admission and discharge and longer rehabilitation stays than patients without brain injury. Thus, the aim of this study was to compare the outcomes of SCI subjects with or without multiple injuries. Methods A total of 245 patients with a traumatic SCI during the first rehabilitation stay after the development of the lesion (202 males and 43 females; age 39.8 ± 17 years; lesion to admission time 51.1 ± 58 days) were examined on a referral basis. Patients were assessed using the following measures: American Spinal Injury Association standards, Barthel Index, Rivermead Mobility Index, and Walking Index for Spinal Cord Injury. The statistical analysis comprised Poisson regression models with relative risks and 95% confidence intervals, adjusted for the following confounders: age, sex, lesion level, and ASIA impairment scale (AIS) grade. Student’s T test was used to compare the outcomes of patients divided by AIS impairment and lesion level. Results SCI patients with and without multiple injuries differed significantly with regard to the level and completeness of the lesion. Overall, patients with multiple injuries had worse functional status at admission and discharge than monotraumatic subjects. However, when adjusted for neurological features, the populations had comparable functional and neurological status at admission and discharge and similar rates of complications and discharge destinations. The separate analysis per each level of lesion/AIS grade showed that in some groups, patients with multiple injuries had a significant longer length of stay or worse functional status at rehabilitation admission (but not at discharge) than their monotraumatic counterparts. Conclusions Multiple injuries do not affect the neurological or rehabilitative prognosis of spinal cord injuries. At discharge, patients with spinal cord injuries with and without multiple injuries achieved similar results with regard to neurological and functional improvement. Some groups of patients with multiple injuries had a longer length of stay.

Background Spinal cord injury (SCI) can damage long tracts, affecting postural stability. Impairments in balance have recently been proposed to be highly predictive of functional recovery in patients with SCI and thus merit evaluation. In addition to common observational clinical scales, more objective evaluation methods of balance can be implemented by analyzing center of pressure (COP) parameters using stabilometric platforms (SPs). COP analysis has been used in various pathologies, but the COP parameters with regard to measurement vary, depending on the features of the target population, and have only been assessed in healthy subjects. Specifically, concerning subjects with SCI, few studies have reported COP parameters, and none has addressed the reliability, validity, or responsiveness of this measure. The objective of this serial cross-sectional study was to analyze the reliability, validity, and responsiveness of COP parameters under various conditions in incomplete SCI subjects to assess balance. Methods Twenty-three patients with incomplete SCI were examined 111 times for 1 year. Each session comprised administration of the Berg Balance scale, Tinetti scale, and WISCI scale and evaluation of stabilometric platform use. Stabilometry was performed under various sensory conditions (OF: open feet; CF: closed feet; OE: open eyes; CE: closed eyes), wherein several COP parameters were analyzed (L: COP path length; V: mean COP velocity, VAP: anteroposterior COP velocity; VLL: laterolateral COP velocity, A: COP ellipse area, SA1: x-axis of COP ellipse area; SA2: y-axis of COP ellipse area). The reliability, validity, and responsiveness of COP parameters that were associated with visual/support area conditions were analyzed. Results Of the COP parameters, V and arithmetically related measures had the highest reliability, validity, and effectiveness scores. Of all test conditions, OE-OF was the most valid, whereas CE-OF was the most responsive. Conclusion The assessment of balance in SCI subjects can be reliable, valid, and effective in acquiring V data, based on OF-OE and OF-CE conditions and heel distance values.