Abstract
Study Design: Prospective cohort study.Objective: This study examined the relationship between motor control and clinical function outcomes after spinal cord injury (SCI).Setting: University of Louisville, Louisville, KY, USA.Materials: Eleven persons with SCI and 5 non-injured subjects were included in this study.Methods: The ASIA Impairment Scale (AIS) was used to categorize injury level and severity. Multi-muscle, surface EMG (sEMG) recording, was carried out using a protocol of reflex and volitional motor tasks and was analyzed using a vector-based tool that calculates index values that relate a distribution of multi-muscle activation pattern of each SCI subject to the prototype obtained from non-injured subject group and presents overall magnitude as a separate value. Functional Independence Measure motor sub-scale, Spinal Cord Injury Independence Measure (SCIM-III), and Walking Index for Spinal Cord Injury (WISCI) scale scores were compared to neurophysiological parameters.Results: AIS category and injury level correlated significantly with the WISCI and SCIM mobility sub-scales. sEMG-derived parameters were significantly correlated with SCIM and WISCI scores but only for examinations carried out 48 or more days post-injury.Conclusion: These results supported the hypothesis that clinically relevant function after SCI is related to the degree to which functional organization within the central nervous system is disrupted. Further, due likely to the constraints placed on the expression of functional ability by early post-injury immobilization and hospitalization, neurophysiological assessment of motor function may provide better sensitivity and reliability than can be obtained using the clinical function scales examined here within the early period after injury.
Highlights
During the past two decades, spinal cord injury (SCI) has seen significant advancement in the areas of neuroprotection, neural repair and regeneration, medical and surgical management, and rehabilitation
ASIA impairment scale (AIS) category and injury level correlated significantly with the Walking Index for Spinal Cord Injury (WISCI) and SCIM mobility sub-scales. surface EMG (sEMG)-derived parameters were significantly correlated with SCIM and WISCI scores but only for examinations carried out 48 or more days post-injury
Due likely to the constraints placed on the expression of functional ability by early post-injury immobilization and hospitalization, neurophysiological assessment of motor function may provide better sensitivity and reliability than can be obtained using the clinical function scales examined here within the early period after injury
Summary
During the past two decades, spinal cord injury (SCI) has seen significant advancement in the areas of neuroprotection, neural repair and regeneration, medical and surgical management, and rehabilitation. The World Health Organization has developed the International Classification of Function (ICF) which is a biopsychosocial schema that evaluates the impact of disease on function and quality of life. The ICF is comprised of three domains: [1] body function and structure (physiological functions and anatomical body parts), [2] activities (execution of a task), and [3] participation (involvement in life situations) [1, 2]. Most outcome scales measure “clinically meaningful” change in the activity and participation domains. The benefit brought by an experimental intervention which improves function within spinal cord neural circuitry may be “lost in the noise” if the outcome measure used assesses activity or participation domains as its endpoint [2]
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