Effects of gender on neurologic and functional recovery after spinal cord injury

Objective: To assess gender differences in neurologic and functional outcome measures in persons with spinal cord injury (SCI). Design: Case series. Settings: Model Spinal Cord Injury Systems (MSCIS) throughout the United States. Participants: People (N=14,433) admitted to an MSCIS within 30 days of injury. Interventions: Not applicable. Main Outcome Measures: Improvement in American Spinal Injury Association (ASIA) motor index score, ASIA Impairment Scale, level of injury, and FIM instrument scores after SCI. Results: When examining subjects grouped by severity of injury, changes in ASIA motor index total scores, from system admission to 1-year anniversary, were significantly greater for women than men with either complete (P=.035) or incomplete (P=.031) injuries. Functional comparison of men and women, using the FIM motor subscale, revealed that men had higher FIM motor scores at rehabilitation discharge among those with motor-complete injuries, except for those with C1-4 and C6 neurologic levels. Women with motor-incomplete high tetraplegia (C1-4 levels) had higher discharge FIM motor scores than did similarly afflicted men. There were no significant differences in FIM motor scores among men and women with other levels of motor incomplete SCI. Conclusions: Gender differences in SCI were seen in several areas. Women may have more natural neurologic recovery than men; however, for a given level and degree of neurologic injury, men tend to do better functionally than women at time of discharge from rehabilitation. Future prospective study of the effects of estrogen on neurologic recovery and the effects of gender on functional potential are recommended.