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 with acute spinal cord injury (SCI) by the American Spinal Injury Association (ASIA) protocol and somatosensory evoked potentials (SSEP). Design: Correlational study on a prospective cohort. Setting: Spinal cord injury center, university hospital. Patients: Consecutively sampled, 70 acute and 34 chronic SCI patients. Main outcome measures: (1) ASIA motor and sensory scores; (2) tibial and pudendal SSEP graded in 5 categories, from normal to absent; (3) ambulatory capacity rated as no, therapeutic, functional, or full. The outcome of the ambulatory capacity was assessed after discharge from the rehabilitation program, at least 6 months after trauma. Results: In acute SCI both the initial ASIA scores 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 score (spearman con. coeff. .90; p < .001) were best related to the outcome of ambulatory capacity. In the early stage of acute SCI, ASIA scores and SSEP recordings can help to assess the outcome of ambulatory capacity and, therefore, can contribute to the selection of the appropriate therapeutic approaches during the rehabilitation program. In patients 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 ambulatory capacity in patients with acute spinal cord injury; in noncomprehensive or uncooperative patients the SSEP are of supplemental value to the clinical examination. Therefore, the combination of clinical and electrophysiological examinations can be of additional diagnostic value in the assessment of acute spinal cord injury. (C) 1997 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation