Novel Quantitative and Functional Outcome Measures for Thoracic Spinal Cord Function after Traumatic Spinal Cord Injury
Suzy Kim, M.D., UC Irvine
Medical Director, Spinal Cord Injury Program; Assistant Clinical Professor Departments of Orthopaedic Surgery & Physical Medicine & Rehabilitation; Scientific Liaison, Reeve-Irvine Research Center

Following thoracic traumatic spinal cord injury (SCI), there is no validated clinical outcome measure to quantitatively and functionally assess thoracic motor function, autonomic function or respiratory function. Currently, the “gold standard” bedside evaluation for sensory and motor function after SCI utilizes the International Standards for Neurologic Classification of SCI (aka ASIA exam). Unlike the cervical and lumbar spinal cord, where there are defined key myotomes and dermatomes, the thoracic spinal cord’s multi-segmented innervation of trunk muscles limits accurate motor assessment. Thus, the neurologic level of classification in thoracic SCI is determined solely by sensory testing of thoracic dermatomes. To date, there is a paucity of scientific and clinical research to correlate thoracic neurologic level of injury (T2-T12) with functional activities such as a forward reach, respiration or locomotion. Paralysis of trunk muscles can compromise spinal alignment leading to a poorly seated position for wheelchair users, skin integrity, respiratory function, wheelchair propulsion and locomotion. We propose the novel development of smart sensor technology and embedded closed loop functional electrical stimulation (FES) control systems to accelerate the introduction of postural muscle strengthening and assessment tools for thoracic SCI into the clinical setting. Without a valid and practical means to measure an accurate neurologic level of thoracic SCI, assessing the safety and efficacy of future potential therapeutic interventions in humans will not be possible as phase 1 human clinical trials will likely target the thoracic SCI population due to a lower risk profile. Furthermore, characterizing postural muscle activity as it correlates with segmental thoracic innervation may platform future studies for evaluating and improving trunk function during wheelchair propulsion, locomotor training, seated activities of daily living, and serve as outcome measures for human clinical trials.

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