METHODS
A review of medical records of eligible subjects was performed by a physical therapist who had not provided care for any of the patients. This retrospective study was approved by the Institutional Review Board at the Chicago Shriners Hospitals for Children. Impairment was measured using neurological level, ASIA Impairment Scale, and ASIA Motor Score as defined by the American Spinal Injury Association and the International Medical Society of Paraplegia (ASIA/IMSOP) International Standards for the Neurological Classification of Spinal Cord Injury (9,10).
Ambulatory status was categorized by the Hoffer classification as nonambulatory, therapeutic, household, and community (11). Individuals were considered community ambulators if they were able to walk indoors and outdoors for most of their activities, although they may use a wheelchair for long trips in the community. Household ambulators were patients who walked only indoors at home or school, and otherwise used a wheelchair for some indoor activities at home and school and for all activities in the community. Therapeutic ambulators were individuals who only walked in therapy sessions at home, at school, or in the hospital. Patients who required a wheelchair for all of their mobility needs were classified as nonambulatory. For purposes of this study, subjects who did not ambulate or ambulated for less than 1 year were considered as nonambulators. Individuals who were nonambulatory but who utilized a standing wheelchair or standing frame were defined as standers. Individuals who were either household or community ambulators were considered functional ambulators. Subjects whose last visit was within 1 year of chart review were considered active and those for whom the last clinical contact was greater than 1 year from the date of the chart review were considered as inactive.
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Statistical analyses were performed using SPSS 11.5. For analyses utilizing duration of brace wear, the data utilized were from 73 patients for whom we had both a starting and end point for brace wear. This included 4 subjects who ambulated for less than 1 year and are otherwise classified as nonambulators for other analyses. Individuals who were still ambulating when they were discharged from our SCI program at age 21 years were not included in these analyses. Logistic regression analyses were performed for the dependent variable of ambulation (ambulation vs nonambulation), with and without ASIA D lesions. Independent variables included age at injury, gender, neurological level, ASIA impairment scale, and ASIA motor scores (both total and lower extremity scores).
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