Can the electrically stimulated manual muscle test differentiate upper from lower motor neuron injury in persons with acute SCI?

OBJECTIVE: To determine if the motor response on the stimulated manual muscle test (SMMT) in muscles with a grade 0 motor score on the manual muscle test (MMT) can differentiate lower motor neuron (LMN) from upper motor neuron (UMN) injury based on the presence of spontaneous activity (SA) with needle EMG. DESIGN: Prospective Study. PARTICIPANTS/METHODS: Twenty-one subjects with acute traumatic cervical SCI. METHODS: An upper extremity International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) evaluation was completed on all subjects. A needle EMG and an electrically stimulated manual muscle test (SMMT) were completed on all key upper extremity muscles with a MMT motor score of zero. RESULTS: The MMT, SMMT and Needle EMG were done on 77 muscles. The SMMT motor score was 0 on 10 muscles and >1 on 67 muscles. The needle EMG identified spontaneous activity (SA) in 55/77 muscles. Seventy percent (7/10) of the muscles with MMT and SMMT motor score of zero demonstrated SA on EMG. Seventy-two percent (48/67) of the muscles with MMT motor score = 0 and SMMT motor score ≥1 demonstrated SA on EMG. CONCLUSION: In our study, 70% of the muscles with a SMMT motor response of zero and 72% of the muscles with a SMMT motor response greater than or equal to one demonstrated SA on EMG. The use of the SMMT as a clinical measure to differentiate LMN from UMN integrity may be limited when applied.

Demonstration of pressure reduction in a new proof of concept spine board.

Pressure injuries are a significant problem following spinal cord injury (SCI). High interface pressures while lying on a spine board during emergency transport appear to play a major role in their formation. The aim of the present study was to assess the interface pressures and sensing area between the body and the standard spine board (SSB) and a proof of concept spine board prototype (P-5). Twenty-one able-bodied subjects were assessed on each board. Interface pressures and sensing area were recorded every minute over 15 min. The mean peak pressure was higher on the SSB at the head, scapulothoracic (S-T), sacroiliac (S-I), and heels (227.6 mmHg, 148.9 mmHg, 360.3 mmHg, and 179.3 mmHg) compared to P-5 (51.9 mmHg, 60.1 mmHg, 66.8 mmHg, and 60.2 mmHg). The peak pressure index (PPI) at the head, S-T and S-I was higher on the SSB (100.2 mmHg, 101.6 mmHg, and 270.6 mmHg) compared to P-5 (41.6 mmHg, 51.9 mmHg and 58.7 mmHg). An analysis using pairwise comparisons for repeated measures showed that interface pressures (p < .05) and PPI (p < .001) were reduced at all locations. Modifications of a spine board incorporated in P-5 can dramatically reduce interface pressures and reduce pressure injury formation.

Redesign of a spine board: Proof of concept evaluation.

Sacral pressure ulcers are a significant problem in individuals following spinal cord injury (SCI) and are felt to be in part due to the high interface-pressures applied to the body while lying on a standard spine board (SSB) during emergency transport. The aim of the present study was to assess the interface pressures and sensing areas between the body and the SSB and two proof of concept spine board prototypes (P-1 and P-2). Ten able-bodied individuals were assessed on each board. Interface pressures and sensing area were recorded every minute over 15 minutes. The highest pressure was generated at the sacral-iliac region. The mean of the peak pressures on the SSB, P-1, and P-2 was 288.6, 202.8, and 102.8 mmHg, respectively. The mean of the sensing areas on the SSB, P-1, and P-2 was 78.2, 98.5, and 109.4 in(2), respectively. An analysis using pairwise comparisons test showed the interface pressures were significantly reduced (p = 0.003) and the sensing area was significantly increased (p < 0.001) on P-2 in the sacral-iliac location. This study's procedures can be used when determining critical factors to guide the redesign of an SSB that reduces interface pressure and increases sensing area.

The Effect of a Liner on the Dispersion of Sacral Interface Pressures During Spinal Immobilization.

Sacral pressure ulcers are a significant problem following spinal cord injury and are felt to be in part due to the high interface-pressures generated while strapped to the spine board. The objective of this study was to determine sacral interface-pressure and sensing area in healthy volunteers on a spine board and the effects of a gel pressure dispersion liner. Thirty-seven volunteers were placed on a pressure-sensing mat between the subject and the spine board. Measurements were carried out with and without a gel liner. Pressures and sensing area were recorded every minute for 40 minutes. The highest pressure was generated at the sacral prominence of each subject. Mean interface-pressures were higher on the spine board alone than with the gel liner (p < .0001). Overall, mean sensing area was lower on the spine board than with the gel liner (p < .0001). Standard spinal immobilization causes high sacral interface-pressures. The addition of a gel liner on the spine board decreased overall mean sacral pressures and increased mean sensing area. Generation of sacral pressure ulcers may be related to the initial interface-pressures generated while the patient is strapped to the spine board. The addition of a gel liner may reduce the incidence of sacral pressure ulcers.