Original Article
Spinal Cord (2009) 47, 56–61; doi:10.1038/sc.2008.66; published online 10 June 2008
Agreement of repeated motor and sensory scores at individual myotomes and dermatomes in young persons with complete spinal cord injury
M J Mulcahey1, J Gaughan2 and R R Betz1
- 1Shriners Hospitals for Children, Philadelphia Hospital, Philadelphia, PA, USA
- 2Biostatistics Consulting Center, Temple University School of Medicine, Philadelphia, PA, USA
Correspondence: Dr MJ Mulcahey, Director of Rehabilitation and Clinical Research, Shriners Hospital for Children, 3551 North Broad Street, Philadelphia, PA 19140, USA. E-mail: mmulcahey@shrinenet.org
Received 10 January 2008; Revised 5 May 2008; Accepted 5 May 2008; Published online 10 June 2008.
Abstract
Study Design:
Prospective repeated measures.
Objectives:
Evaluate intra-rater agreement of repeated motor and sensory scores at individual spinal levels.
Setting:
Non-profit pediatric rehabilitation center.
Methods:
Fifty-eight youth with complete spinal cord injury undergoing two neurological exams. Agreement between exams for each myotome and dermatome was evaluated for four neurological groups: C1–C4 (N=9); C5–C8 (N=8); T1–T6 (N=22); T7–T12 (N=19). Kappa (k) and weighted k (kw) coefficients were calculated.
Results:
Agreement between strength scores was 99 and 100% in subjects with tetraplegia and paraplegia, respectively. C1–C4: pin prick (PP)=absolute agreement (AA) in 57% dermatomes (D) (k range=0.10–0.83; kw range=0.36–0.93). Light touch (LT)=AA in 59% D (k range=0.35–0.77; kw range=0.34–0.84). C5–C8: PP=AA in 86% D (k range=0.28–0.78; kw range=0.43–0.93). LT=AA in 80% D (k range=0.10–0.80; kw range=0.12–0.91). T1–T6: PP=AA in 82% D (k range=0.36–0.83; kw=0.20–0.96). LT=AA in 77% D (k range=0.23–0.89; kw range=0.23–0.89). T7–T12: PP=AA in 82% D (k range=0.46–0.90; kw range=0.54–0.90). LT=AA in 84% D (k range=0.41–0.87; kw range=0.52–0.94).
Conclusion:
Overall, agreement was excellent for myotome comparisons. For the C5–C8, T1–T6 and T7–T12 groups, there are variations in sensory scores within three levels of the neurological level (NL). For the C1–C4 group, variation in sensation extended well caudal to the NL. The International Standards for Neurological Classification of Spinal Cord Injury is a good outcome measure for a single-site, one-rater study but differences in repeated sensory scores at individual D were found, which should be considered in the interpretation of results of outcome studies.
Keywords:
International Standards for Neurological Classification of Spinal Cord Injury, tetraplegia, paraplegia, neurological examination
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