FUNCTIONAL OUTCOME FOLLOWING SPINAL-CORD INJURY - SIGNIFICANCE OF MOTOR-EVOKED POTENTIALS AND ASIA SCORES

Objective: Prediction of outcome of ambulatory capacity and hand funct ion in tetraplegic patients with spinal cord injury (SCI) using neurol ogic examination, according to the protocol of the American Spinal Inj ury Association (ASIA) and motor-evoked potentials (MEP). Design: Corr elation study on a prospective cohort. Setting: SCI center, university hospital. Patients: Thirty-six patients with acute and 34 with chroni c SCI. Outcome Measures: (1) ASIA motor and sensory scores, (2) MEP re cordings of upper and lower limb muscles, and (3) outcome of ambulator y capacity and hand function. Results: In acute and chronic SCI, both the initial ASIA scores and the MEP recordings were significantly rela ted (p < .0001) to the outcome of ambulatory capacity and hand functio n. In tetraplegic patients, the MEP of the abductor digiti minimi musc le (Spearman correlation coefficient, .75; p < .0001) and the ASIA mot or score for the upper limbs (Spearman correlation coefficient, .83; p < .0001) were most related to the outcome of hand function. Ambulator y capacity could be predicted by the ASIA motor score of the lower lim bs (Spearman correlation coefficient, .78: p < .0001) and by MEP recor dings of the leg muscles (Spearman correlation coefficient, .77; p < . 0001). In patients with acute SCI, for the period 6 months posttrauma, the ASIA motor score increased significantly (ANOVA, p < .05), wherea s the ASIA sensory scores and MEP recordings were unchanged (ANOVA, p > 0.1). Conclusion: Both ASIA scores and MEP recordings are similarly related to the outcome of ambulatory capacity and hand function in pat ients with SCI. MEP recordings are of additional value to the clinical examination in uncooperative or incomprehensive patients, The combina tion of clinical examination and MEP recordings allows differentiation between the recovery of motor function (hand function, ambulatory cap acity) and that of impulse transmission of descending motor tracts. (C ) 1998 by the American Congress of Rehabilitation Medicine and the Ame rican Academy of Physical Medicine and Rehabilitation.