Electrophysiological Evaluation of the Patient with Acute Spinal Cord injury

Clinical Algorithm for Improved Prediction of Ambulation and Patient Stratification after Incomplete Spinal Cord Injury

“…We acknowledge that in several translational studies predictive measures need to be obtained at earlier time points (<16 days), as therapeutic interventions might start early (3-14 days) or almost immediately (1-2 days) after trauma (Dietz and Curt, 2006). Since SSEP recordings are less dependent on the active cooperation of the patient and even feasible during surgery, they might be applicable at early time points after injury as objective and reliable predictors in miSCI (Curt and Dietz, 1997;Curt et al, 2008;Deletis and Sala, 2008;Grundy and Friedman, 1987;Houlden et al, 1992;Kelleher et al, 2008). A similar approach represents motor-evoked potentials (MEPs), where initial assessments can either be performed in awake and cooperative patients or under anesthetics as developed for intraoperative monitoring (Deletis and Sala, 2008;Kelleher et al, 2008).…”

Electrophysiological Predictors of Lower Limb Motor Recovery: The Rehabilitation Perspective

“…These noninvasive and precise tests have the potential to fill the field's need for a tool that can predict outcome early after injury. 8,[24][25][26][27] Sensory and motor evoked potentials and reflex testing can provide information beyond the clinical exam, be completed in impaired patients, help more completely characterize the injury, and detect changes, allowing prompt responses in treatment plans. 8,26,28 Electrophysiological assessments offer the potential to detect subclinical changes in neurological functioning because they are objective and much more sensitive than the AIS or functional tests.…”

“…8,[24][25][26][27] Sensory and motor evoked potentials and reflex testing can provide information beyond the clinical exam, be completed in impaired patients, help more completely characterize the injury, and detect changes, allowing prompt responses in treatment plans. 8,26,28 Electrophysiological assessments offer the potential to detect subclinical changes in neurological functioning because they are objective and much more sensitive than the AIS or functional tests. 6,8,12,14,15,27,[29][30][31] The tests are sensitive not only for monitoring recovery of motor and sensory capacity as well as spasticity but also for establishing baseline measures of impairment.…”

“…Sensory evoked potentials demonstrate the integrity of sensory impulse transmission, are not affected by spinal shock, and can be conducted in unconscious patients, whereas motor evoked potentials demonstrate the integrity of motoneuron pathways, can be conducted painlessly in conscious patients, and can be used to supplement the clinical exam in characterizing the injury and assessing its extent. 8,26 Peripheral testing, such as EMGs and reflex assessments, can be used to distinguish peripheral lesions, assess motoneuron functioning, and detect the development of neuropathologies, such as spasticity. 8,26,34 There are many different protocols for electrophysiological tests, but they all share the same basic principles.…”

Electrophysiological recordings in patients with spinal cord injury: significance for predicting outcome

“…As electrophysiological recordings allow the objective assessment and distinguishing between lesions of di erent parts of the peripheral and central nervous systems they are of supplementary value to the clinical examination and especially of importance in patients who are not able to cooperate. 1 The aim of this review is: (1) to illustrate the signi®cance of electrophysiological recordings in the diagnostic and prognostic assessment of patients with acute SCI in relation to the clinical examination, (2) to describe the most reliable recordings for predicting the outcome of di erent functions in SCI patients, and (3) to monitor the extent of recovery of spinal cord function (by recording spinal impulse transmission) in relation to the degree of functional improvement during the rehabilitation programme. The indications and limitations of electrophysiological recordings in the diagnostic assessment of acute SCI patients and their value in comparison to the clinical examination are discussed.…”