AMBULATORY CAPACITY IN SPINAL-CORD INJURY - SIGNIFICANCE OF SOMATOSENSORY-EVOKED POTENTIALS AND ASIA PROTOCOL IN PREDICTING OUTCOME

Objective: Prediction of outcome of ambulatory capacity in patients wi th acute spinal cord injury (SCI) by the American Spinal Injury Associ ation (ASIA) protocol and somatosensory evoked potentials (SSEP). Desi gn: Correlational study on a prospective cohort. Setting: Spinal cord injury center, university hospital. Patients: Consecutively sampled, 7 0 acute and 34 chronic SCI patients. Main outcome measures: (1) ASIA m otor and sensory scores; (2) tibial and pudendal SSEP graded in 5 cate gories, from normal to absent; (3) ambulatory capacity rated as no, th erapeutic, functional, or full. The outcome of the ambulatory capacity was assessed after discharge from the rehabilitation program, at leas t 6 months after trauma. Results: In acute SCI both the initial ASIA s cores and the SSEP recordings are related (p < .001) to the outcome of ambulatory capacity. In acute tetraplegia the pudendal SSEP (spearman corr. coeff. .92; p < .001) and in acute paraplegia the ASIA motor sc ore (spearman con. coeff. .90; p < .001) were best related to the outc ome of ambulatory capacity. In the early stage of acute SCI, ASIA scor es and SSEP recordings can help to assess the outcome of ambulatory ca pacity and, therefore, can contribute to the selection of the appropri ate therapeutic approaches during the rehabilitation program. In patie nts with acute SCI the ASIA motor score significantly increased (p < . 05) in the 6 months after trauma, whereas the ASIA sensory scores and SSEP recordings did not change significantly during this same period. Conclusion: ASIA scores and SSEP are related to the outcome of ambulat ory capacity in patients with acute spinal cord injury; in noncomprehe nsive or uncooperative patients the SSEP are of supplemental value to the clinical examination. Therefore, the combination of clinical and e lectrophysiological examinations can be of additional diagnostic value in the assessment of acute spinal cord injury. (C) 1997 by the Americ an Congress of Rehabilitation Medicine and the American Academy of Phy sical Medicine and Rehabilitation