Evaluation of treatment in patients after thoracic spinal cord injury
Journal Title: Issues of Rehabilitation, Orthopaedics, Neurophysiology and Sport Promotion-IRONS - Year 2015, Vol 10, Issue 10
Abstract
Introduction The effectiveness of rehabilitation of patients after spinal cord injuries should be objectively verified at successive stages of the therapy. Commonly used methods such as clinical evaluation with ASIA scale, for understandable reasons are characterized by subjectivity of evaluation in relation to the person performing the test and examined patient. Aim This paper presents possible and optimal for physiotherapists algorithm for non-invasive diagnostic procedure using clinical and neurophysiological methods on the example of research in group of patients with incomplete spinal cord injuries. The main aim of study was to compare the results of clinical functional assessment, results of neuroimaging and clinical neurophysiology examinations in patients with incomplete thoracic spinal cord injuries similarly treated with surgical and conservative procedures. Materials and methods There was performed an analysis of comparative studies of clinical (ASIA scale, MRI) and neurophysiological evaluation (sEMG surface electromyography tests during muscle’s relaxation and maximal contraction, the study of central and peripheral efferent neural transmission MEP and sensory perception study with von Frey’s filaments) in 12 patients with thoracic spinal cord injuries. Results and conclusions Result of comprehensive clinical evaluation with ASIA scale demonstrated in eight patients C type damage and D type in four patients. These patients were characterized with remained motor function below the level of injury (average score 3 in Lovett’s scale) with a symptom of lateralization. Picture of incomplete structural damage shown in MRI studies on T2-T12 levels corresponds to functional deficits identified in the sEMG study during maximal muscles contraction in the lower extremities more than in rectus abominis muscles. Results of efferent transmission MEPs studies are consistent with the results of clinical assessment and efficiency of muscle motor units studied in sEMG recordings. The results of sensory dermatomes examinations under clinical evaluation in the ASIA scale have shown more deficiencies in innervation from the level of C8-T1 rather than the results of von Frey’s filaments tests, which clarified the symptoms analgesia in distal parts of lower extremities.
Authors and Affiliations
Agnieszka Wincek
Keywords
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