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

Abstract

Context/Objective: To evaluate the accuracy of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) motor examination in individuals with spinal cord injury (SCI) with motor grade 0 or 1 and analyze its degree of concordance with needle electromyography (EMG) findings for each key muscle.

Design: Retrospective study.

Setting: University hospital in Goyang, Korea.

Participants: Individuals with SCI admitted to the Department of Rehabilitation from January 2013 to June 2019.

Interventions: In the enrolled persons, needle EMG was performed on muscles with motor grade 0 or 1 on ISNCSCI examination, and muscle contraction was confirmed through the detection of motor unit action potential.

Outcome measures: The agreement between motor examination and needle EMG findings was analyzed.

Results: 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. We found a fair agreement between motor examination and needle EMG findings (κ = 0.309, P < 0.0001). Moreover, statistically significant agreement was seen only in T1, L2, and S1 key muscles (κ = 1, P < 0.0001; κ = 0.359, P = 0.019; and κ = 0.521, P = 0.004, respectively).

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

Keywords:

• Spinal cord injury
• International standards for neurological classification of spinal cord injury motor examination
• Motor power
• Electromyography

Data availability statement

The data generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

Conflict of interests

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was not funded by any universities, charities, or commercial organizations, as well as sources of any study materials.