Correlation Between Clinical Assessment and Neurophysiological Assessment in Spinal Cord Injury

This study is a cross-sectional study that aims to explore the correlation between clinical assessment and neurophysiological assessment in SCI. The clinical outcome assessment are modified-Modified Ashworth scale (m-MAS) and lower extremity motor score. The neurophysiological outcome is H-reflex outcome.

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Key information

Conditions

Incomplete Spinal Cord Injury Central Nervous System Diseases Muscle Hypertonia Muscle Spasticity Muscular Diseases Musculoskeletal Diseases Nervous System Diseases Neurologic Manifestations Neuromuscular Manifestations Paralysis Paraplegia Pathological Conditions, Signs and Symptoms Quadriplegia Signs and Symptoms Spastic Paraplegia Spastic Tetraplegia Spinal Cord Diseases Spinal Cord Injuries Spinal Cord Injury Trauma, Nervous System Wounds and Injuries

Age range

18 year–70 year

Sex eligibility

All sexes

Study type

Observational

Primary location

Mahidol University

Nakhon Pathom, Salaya, 73170, Thailand

About this study

Spinal cord injury (SCI) cause disruption of descending control pathway in spinal cord. The disruption of descending control induce impaired motor and sensory function below the level of injury, as well as the electrical signal from supraspinal pathway. During spinal shock phase, spinal motoneuron become hypoexcitability, as resulting in muscle hypotonicity or flaccidity in clinical manifestation. The spinal motoneuron gradually increase during sub-acute to chronic phase as resulting in development of spasticity in SCI. Development of spasticity is realted to increase of spinal motoneuron excitability, which shown in a decrease in H-reflex latency and increase in Hmax/Mmax ratio. A previous study shown a medium correlation between Hmax/Mmax ratio and MAS in SCI and stroke people. Moreover, the MAS shown a strong correlation with Fugle-meyer score in stroke people. However, it remains unclear in correlation between clinical outcome and neurophysiological outcome assessment of spasticity, and the correlation of spasticity and the motor function in SCI.

This study aims to explore the correlation between clinical assessment and neurophysiological assessment of spasticity in SCI.The clinical outcome assessment are modified-Modified Ashworth scale (m-MAS) and lower extremity motor score (LEMS). The lower extremity motor score is obtained from American Spinal Injury Association (ASIA) imapirement scale. The neurophysiological outcome assessment is H-reflex methode. All particiants who will participated into this study will be assessed the m-MAS, LEMS and H-reflex.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

Individuals with any level of SCI with age between 18-70 years.
Onset of injury between 1-30 month.
Presentation of H-reflex.

Exclusion criteria

Having history of other neurological disease e.g. stroke
Absent of H-reflex.

Treatment and study plan

Primary outcomes

modified-Modified Ashworth scale

Time frame: 1 day

The modified-Modified Ashworth scale is a clinical outcome to evaluate level of spasticity in neurological patient. The MAS consists of 6 grading scale, range from 0 to 5; (i) 0: no increase in muscle tone or normal, (ii) 1: slight increase in muscle tone, with a cathch and release or minimal resistance at the end of the range of motion, (iii) 4: slight increase in muscle tone, manifested as a cathch, followed by minimal resistance through the remainder (less than half) of the range of motion, (iv) 3: a marked increase in muscle tone throughout most of the range of motion, but affected parts still easily moved, (v) 4: considered increase in muscle tone, passive movement difficult, (vi) 4: affected parts rigid in flexion or extension.
Lower extremity motor score

Time frame: 1 day

The lower extremity motor score (LEMS) is obtained from American Spinal Injury Association (ASIA) imapirment scale. The ASIA imapirment scale consists of motor, sensory and anorectal examination. This assessment is an standard assessment form for SCI. The lower extremity motor score assess 5 key lower extremity muscles. which are hip flexors, knee extensors, ankle plantar flexors, ankle dorsiflexors and long toe extensors. These 5 key muscles represent motor recovery throughout myotome of the body. Grading of this assessment range from 0 to 5, according to mannual muscle testing grading system.
Soleus H-reflex

Time frame: 1 day

A most reliable are for assess spinal motoneuron excitability is soleus H-reflex. The stimulation electrode place over the popletial fossa to stimulate tibial nerve. Two disposal surface electrode place over 1/3 of lower leg which is over the soleus muscle. Data from the assessment are H-reflex latency, H-reflex amplitude, M-wave response amplitude.

Sponsors and collaborators

Lead sponsor

Mahidol University

Other

Registry information

Important dates

Study start: 2024
Primary completion: 2024
Study completion: 2025
First posted: Nov 8, 2024
Registry last updated: Jun 25, 2025

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View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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Completed