PREVALENCE OF DISCOMPLETE SENSORIMOTOR SPINAL CORD INJURY AS EVIDENCED BY NEUROPHYSIOLOGICAL METHODS: A CROSS-SECTIONAL STUDY

Journal of Rehabilitation Medicine, 2021 · DOI: 10.2340/16501977-2774 · Published: December 4, 2020

Spinal Cord Injury Physiology Rehabilitation

Simple Explanation

Spinal cord injuries are usually classed as complete or incomplete. A complete injury implies that no residual function exists below the neurological level of injury. The aim of the current study was to examine whether residual function, which is not detected by such testing, exists, and, if so, how common it is among people with complete spinal cord injuries (based on clinical testing) in a chronic stage (>2 years since injury). Signs of “subclinical” residual function were found in 17–39% of 23 participants. This finding may lead to improvements in rehabilitative outcomes for people with complete spinal cord injury.

Study Duration

Not specified

Participants

23 adults with chronic sensorimotor complete spinal cord injury

Evidence Level

Cross-sectional study

Key Findings

1
Strong neurophysiological evidence of discomplete spinal cord injury was found in 17% (4/23) of participants.
2
If also accepting “possible evidence”, the discomplete group comprised 39% (9/23).
3
However, if also counting reports of subjective sensation elicited during neurophysiological testing in the absence of objective findings, 52% (12/23) showed indication of discomplete spinal cord injury.

Research Summary

Evidence of discomplete spinal cord injury can be demonstrated using standard neurophysiological techniques in a substantial subset of individuals with clinically complete spinal cord injury. This study adds to the evidence base indicating the potential of various modes of cross-lesional sensori-motor functional restoration in some cases of chronic clinically complete spinal cord injury. The current study assessed the neurophysiological indications of trans-lesional sensorimotor connectivity in people with clinically complete, chronic SCI.

Practical Implications

Rehabilitation Improvements

The finding of residual subclinical function in individuals with clinically complete SCI may lead to improvements in rehabilitative outcomes.

Neuromodulation Applications

Identification of dSCI may prove to be of great clinical importance for the application of neuromodulation (such as navigated TMS) in neurological rehabilitation.

Diagnostic Protocol Refinement

Further studies are needed to define which methods to use, possibly in combination, in order to establish a reliable protocol for identifying and characterizing dSCI in clinical practice.

Study Limitations

1
The study did not include sensory fMRI, a method that recent studies indicate to be a sensitive means to detect remaining connections.
2
The study might have lacked the statistical power to shed light on the influence of dSCI on spasticity or neuropathic pain.
3
The study did not employ techniques such as capsaicin sensitization of peripheral nerve endings.

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