Rehabilitation goals for hand and upper extremity function after cervical spinal cord injury: A retrospective study
Bibliographic record
Abstract
CONTEXT: Patient goals are critical when determining surgical options for restoration of hand function in spinal cord injury (SCI). OBJECTIVE: We characterized the discussion of goals specific to hand function during acute rehabilitation admission at a single Canadian center following cervical SCI, before the introduction of a hand surgery program for the tetraplegia population. METHODS: A retrospective chart review of a single-center adult rehabilitation hospital from 2012 to 2022 of traumatic cervical SCI admissions was conducted. Charts were reviewed for discussion of specific goals that require hand function and recorded for analysis. Hand function goals were categorized and mapped to Canadian Occupational Performance Measures (COPM) domains, and patterns were analyzed on a population level. RESULTS: Over ten years, 134 individuals with acute traumatic SCI were admitted, 88 met study inclusion criteria with documented goals requiring hand function, and 32 unique goal types were recorded. The most common goal domain across all AIS categories was functional mobility. Motor complete patients primarily had self-care goals. Leisure and productivity goals were overall rarely captured. Most documented goals focused on basic activities of daily living (ADLs). CONCLUSIONS: We observed a historical emphasis on hand function goals of ADLs, but not capturing the depth and breadth of other domains where hand function is essential. With the development of hand surgery programs in the tetraplegia population, standardized tools and detailed discussion of hand function goals may better capture patient priorities, including productivity and leisure, and improve our discussion of functional outcomes when evaluating the success of surgery.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".