Reliability of S3 pressure sensation and voluntary hip adduction/toe flexion and agreement with deep anal pressure and voluntary anal contraction in classifying persons with traumatic spinal cord injury

The Journal of Spinal Cord Medicine, 2020 · DOI: 10.1080/10790268.2019.1628496 · Published: September 1, 2020

Spinal Cord Injury Neurology Rehabilitation

Simple Explanation

The standard sacral exam after spinal cord injury can be difficult to perform. This study looks at alternative tests. The study tests pressure sensation at the S3 dermatome (S3P) and voluntary hip adductor/toe flexor contraction (VHTC) as alternatives. The study found S3P and VHTC to be reliable and in agreement with standard tests, especially in injuries above T10.

Study Duration

1-month baseline test–retest reliability study, with follow-up examinations at 3, 6, and 12 months

Participants

51 subjects with acute traumatic SCI, neurological levels T12 and above, AIS grades A–C

Evidence Level

Longitudinal cohort study

Key Findings

1
Test–retest reliability indicated perfect agreement (kappa = 1.0) for all data except S3P (kappa = 0.96).
2
The agreement was almost perfect between S3P and DAP (kappa = 0.84) and between VHTC and VAC (kappa = 0.81).
3
VHTC and VAC differed more often with neurologic levels below T10, possibly due to root escape in conus medullaris injuries.

Research Summary

This study evaluated the reliability and agreement of S3 pressure sensation (S3P) and voluntary hip adductor/toe flexor contraction (VHTC) as alternatives to deep anal pressure (DAP) and voluntary anal sphincter contraction (VAC) in classifying persons with traumatic spinal cord injury (SCI). The results showed excellent test–retest reliability for all sacral examination elements and high agreement between S3P and DAP, and VHTC and VAC. The study suggests that S3P and VHTC may be reasonable alternatives to DAP and VAC, particularly in injuries above T11, but caution is advised in conus injuries due to potential root escape.

Practical Implications

Clinical Practice

S3P and VHTC can be considered as alternatives to DAP and VAC, especially when standard examinations are difficult to perform or not tolerated by the patient.

Acute Assessment

These alternative tests may be valuable in the acute assessment of persons with polytrauma, particularly when the pelvis is involved.

Conus Lesions

Including both DAP, S3P, VAC, and VHTC in the evaluation may contribute to the identification of subtypes in conus, supraconus, and cauda equina injuries.

Study Limitations

1
Small sample size with an uneven distribution among AIS grade classifications at baseline.
2
Examinations were conducted by research personnel who had undergone InSTeP training, potentially limiting generalizability.
3
The retest for reliability was usually performed 1–3 days after the first test, potentially biasing results.

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