Trends in Pressure Injury Development in Patients With Lower Motor Neuron and Upper Motor Neuron Lesions: A Retrospective Descriptive Study

BACKGROUND: Persons with spinal cord injury (SCI) are at high risk of pressure injury (PrI) development, but there is limited information about the effect of injury patterns (ie, upper motor neuron [UMN] or lower motor neuron [LMN] presentations) on PrI risk. PURPOSE: This study was conducted to explore the rate of PrI development in patients with LMN and UMN lesions. METHODS: A retrospective descriptive review of data from patients who were treated at a specialized outpatient SCI rehabilitation center in Baltimore, MD, between January 1, 2013, and December 31, 2019. Patients with neurological levels T8 and below, any type of SCI motor ability, and whose records were complete were included in the study. Data extracted included age, sex, date of injury, injury type, modified Ashworth Scale (MAS) score (ie, scale representing resistance to passive movement), date MAS was performed, body mass index, Spinal Cord Independent Measures-III, Braden Scale scores, ambulatory status, antispasticity medication, presence or history of PrI, and method of closure. Patients with a score of 0 on the MAS and without pharmacological management for spasticity were included in the LMN group, and patients with a score greater than 0 on the MAS with or without pharmacological management were included in the UMN group. Variables were compared using mean ± standard deviations, range, t-test, and Pearson’s chi-squared and Fisher exact tests where appropriate. P values < .05 were considered statistically significant. RESULTS: Of the 602 records examined, 194 were complete and met inclusion criteria. Most patients (119, 61.34%) were male and classified in the UMN group (162, 84%). Mean age and time since injury were 35.20 ± 18.78 and 6.20 ± 7.62 years, respectively. Seventy-three (73) of 194 patients (37.6%) had, or had a history of, a PrI; 21 (66%) in the LMN and 52 (32%) in the UMN group (X21 = 12.8; P < .001). Statistically significant differences were noted between persons with LMN and UMN in terms of Braden Scale scores, age, body mass index, Spinal Cord Independent Measures-III, and time since injury. Compared with the UMN group, more patients in the LMN group had motor complete injuries with ISNCSCI levels A/B (P < .001) and were nonambulatory (P < .001). CONCLUSION: The results of this study confirm that patients with SCI have a high rate of PrI development. The percentage of PrIs was significantly higher in the LMN than in the UMN group. Additional studies to examine the other variables that were significantly different between groups and their effect on PrI risk are needed.