Concordance between the international standards for neurological classification of spinal cord injury motor examination and needle electromyography findings in muscles with a motor power grade of zero or trace

The Journal of Spinal Cord Medicine, 2023 · DOI: 10.1080/10790268.2021.2021044 · Published: May 1, 2023

Simple Explanation

This study examines the accuracy of the standard motor exam for spinal cord injury (SCI) patients who have very weak or no movement in certain muscles. The researchers compared the motor exam results with a more sensitive test called needle electromyography (EMG), which detects even small amounts of muscle activity. The goal was to see if the standard exam accurately reflects the actual muscle activity, which is important for planning the best rehabilitation and predicting recovery.

Study Duration

January 2013 to June 2019

Participants

27 individuals with SCI

Evidence Level

Retrospective study

Key Findings

1
The agreement between the standard motor exam and needle EMG was only fair overall, meaning there were discrepancies between the two methods.
2
The standard exam was more accurate when it detected no muscle activity (grade 0) compared to when it detected a trace amount of activity (grade 1).
3
Agreement varied depending on the specific muscle being tested, with some muscles showing better agreement than others.

Research Summary

This study evaluated the accuracy of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) motor examination in individuals with SCI with motor grade 0 or 1 and analyzed its degree of concordance with needle electromyography (EMG) findings for each key muscle. In 175 key muscles, needle EMG findings in 115 and 60 muscles evaluated as grades 0 and 1 on ISNCSCI examination showed 80% and 50% agreements, respectively. It is important to accurately distinguish between grade 0 and 1 motor power to maximize the positive outcomes from rehabilitation treatment and predict the possibility of recovery in individuals with SCI.

Practical Implications

Improved Accuracy in Motor Assessment

Needle EMG confirmation could be considered for muscles with motor grade 0 or 1 in individuals with SCI to improve the accuracy of motor examination and the American Spinal Injury Association Impairment Scale.

Optimized Rehabilitation Strategies

Accurately distinguishing between grade 0 and 1 motor power can help maximize positive outcomes from rehabilitation treatment and better predict the possibility of recovery in individuals with SCI.

Enhanced AIS Classification

Considering needle EMG findings can lead to more accurate AIS evaluations, which is crucial for predicting motor power and functional recovery in persons with SCI.

Study Limitations

1
The study did not analyze non-key muscles.
2
The number of cases for each key muscle was not large enough to produce meaningful results for all muscles.
3
Motor examination was not performed within one week after the occurrence of SCI.

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