Abstract Information


Assessment of Trunk Muscle in Human Spinal Cord Injury:Discovery of Volitional Movement Below the Level of Injury

1O'Brien K, 2Atkinson D, 1Ochsner J, 3Tolfo C, 2Harkema S, 4Wyles E
1Frazier Rehab Institute, Louisville, KY, USA; 2University of Lousville, Louisville, KY, USA; 3Frazier Rehab, Louisville, KY, USA; 4University of Louisville, Louisville, KY, USA

Objective: Spinal cord injury affects not only the upper and lower extremities, but has a debilitating effect on the trunk musculature as well. The axial trunk musculature is responsible for the simultaneous maintenance of posture, balance, respiration and stabilization of the axial spine in order for movement of the extremities to occur. Clinically, the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) (1) is widely used to classify motor and sensory level, and severity of injury after SCI. The ISNCSCI is commonly used in the determining prognosis for functional recovery. However, the ISNCSCI exam is not designed to measure the activation of the trunk musculature innervated by the thoracic segments. The Neuromuscular Recovery Scale (NRS) (2) is a clinical measure of functional neuromuscular capacity in the absence of compensation or external assistance, and may provide additional evidence of volitional muscle activity well below the neurologic level of lesion (NLI). The Functional Neurophysiological Assessment (FNPA), a standardized, electromyography(EMG)- based assessment which can be utilized in both clinical and research settings(3). The FNPA can provide improved sensitivity in assessing motor function through the simultaneous monitoring of neuromuscular activation in multiple neck, arm, trunk, and leg muscles.
Design/Method: A total of 23 individuals with SCI (AIS A=9, AIS B=8, AIS C=3, AIS D-=3, 16 cervical and 7 thoracic level of injury) underwent 80 sessions of locomotor training in the locomotor training clinic at Frazier Rehab Institute in Louisville, KY, and completed a pre- and post-intervention FNPA, as well as NRS and ISNCSCI assessments. The intervention consisted of 1 hour of locomotor training in a body weight-supported treadmill environment, plus 30 minutes of overground training, provided 5 days per week, with re-evaluation occurring every 20 sessions (~monthly).
Results: 20 (86%) of participants, including all AIS A patients evaluated, could volitionally activate the erector spinae muscles recorded at the T10 to T12 level, while 8 (34%) demonstrated volitional activation of rectus abdominus. NRS trunk scores also demonstrated functional activation at levels much lower than the NLI in most participants, but did not exhibit the sensitivity of the FNPA in identifying volitional neuromuscular activity below the expected level of injury.
Conclusion: The FNPA detected neuromuscular activity below the level of injury that was not identified in clinical assessments. The FNPA may be a desirable supplement, where available, as it provides an objective, quantitative measure of neuromuscular function throughout the cervical, thoracic, and lumbosacral segments of the spinal cord after SCI. Similarly, the NRS may provide additional insight to an individual’s current and future functional abilities, especially when FNPA equipment is unavailable.


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