Model System:

SCI

Reference Type:

Journal article

Accession No.:

J84720

Journal:

Journal of Spinal Cord Medicine - JSCM (formerly Journal of the American Paraplegia Society)

Year, Volume, Issue, Page(s):

, 43, 5, 616-622

Publication Website:

Abstract:

The sacral examination components of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), namely deep anal pressure (DAP) and voluntary anal sphincter contraction (VAC), are often difficult to perform. This study evaluated the reliability of voluntary hip adductor and toe flexor muscle contraction (VHTC) as an alternative to VAC after spinal cord injury (SCI). It also assessed the agreement between the classification of completeness using pressure sensation at the S3 dermatome (S3P) and VHTC compared to DAP and VAC. The ISNCSCI examination, S3P, and VHTC were conducted at 1-month post-injury; retest of the sacral exam, S3P, and VHTC were within 3 days. Follow-up examinations performed at 3, 6, and 12 months. Participants were subjects with acute traumatic SCI, neurological levels T12 and above, who were admitted to one of five participating SCI Model System Centers. Fifty-one subjects had 1-month data, and 39 had at least one follow-up examination. Test-retest reliability indicated perfect agreement (kappa = 1.0) for all data except S3P (kappa = 0.96). The agreement was almost perfect between S3P and DAP (kappa = 0.84) and between VHTC and VAC (kappa = 0.81). VHTC and VAC differed more often with neurologic levels below T10, possibly due to root escape in conus medullaris injuries. S3P and VHTC show promise as alternatives to DAP and VAC for determining sacral sparing in persons with neurologic levels T10 and above. Reliability and agreement should be evaluated at earlier timepoints and in children with SCI.

Author(s):

Marino, Ralph J. |Schmidt-Read, Mary |Chen, Anna |Kirshblum, Steven C. |Dyson-Hudson, Trevor A. |Field-Fote, Edelle |Zafonte, Ross|

Participating Centers: