Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Rehabilitation, Inje University Ilsan Paik Hospital, Gyeonggi-do, Republic of Korea.
PM R. 2024 Mar;16(3):210-218. doi: 10.1002/pmrj.13032. Epub 2023 Sep 8.
When it is difficult to determine whether a muscle is grade 0 or 1, manual muscle test (MMT) accuracy can be further improved by using needle electromyography (EMG) as a supplementary and confirmatory examination tool.
To evaluate concordance between needle EMG and MMT findings for key muscles with motor grades 0 and 1 on the International Standards of Neurological Classification of Spinal Cord Injury (ISNCSCI) examination, and to potentially improve the prognosis for grade 0 muscles with proven muscle activity based on needle EMG findings.
A retrospective analysis.
Inpatient tertiary rehabilitation facility.
Not applicable.
One hundred seven patients with spinal cord injury (SCI) admitted for rehabilitation (n = 1218 key muscles, grades 0 or 1).
Inter-rater reliability between MMTs and needle EMG was analyzed using Cohen's kappa coefficient (κ). A Mantel Haenszel linear-by-linear association chi-square test was used to determine whether the presence of motor unit action potentials (MUAPs) in muscles graded 0 on the initial MMT at admission was associated with MMT grades at discharge and readmission.
Moderate-to-substantial agreement between needle EMG and MMT findings was observed (κ = 0.671, p < .01). Concerning key upper and lower extremity muscles, moderate and substantial agreement was identified, respectively. The lowest agreement was noted for C6 muscles. During follow up, 68.8% of muscles with proven MUAPs showed improved motor grades.
At initial assessment, distinguishing between motor grades 0 and 1 is imperative because motor grade 1 muscles are more likely to have a better prognosis for improvement. Moderate-to-substantial agreement was observed between MMT and needle EMG findings. The MMT is a reliable method of muscle grading, yet needle EMG may be of value in certain clinical situations to evaluate for the presence of MUAPs when evaluating motor function.
当难以确定肌肉是否为 0 级或 1 级时，可使用针极肌电图（EMG）作为补充和确认检查工具，进一步提高手动肌肉测试（MMT）的准确性。
评估国际脊髓损伤神经分类标准（ISNCSCI）检查中关键 0 级和 1 级运动肌的针极 EMG 与 MMT 结果的一致性，并根据针极 EMG 结果确定具有肌肉活动的 0 级肌肉的潜在预后。
回顾性分析。
住院三级康复机构。
不适用。
107 例因脊髓损伤（SCI）接受康复治疗的患者（n=1218 个关键肌肉，0 级或 1 级）。
使用 Cohen 的kappa 系数（κ）分析 MMT 和针极 EMG 之间的观察者间可靠性。采用Mantel-Haenszel 线性线性关联卡方检验，确定入院时初始 MMT 分级为 0 的肌肉中运动单位动作电位（MUAPs）的存在是否与出院和再次入院时的 MMT 分级相关。
针极 EMG 与 MMT 结果之间存在中度至高度一致性（κ=0.671，p<0.01）。在上肢和下肢关键肌肉中，分别观察到中度和高度一致性。C6 肌肉的一致性最低。在随访期间，68.8%的具有 MUAPs 证实的肌肉运动等级得到改善。
在初始评估时，区分 0 级和 1 级运动肌至关重要，因为 1 级运动肌更有可能改善预后。MMT 和针极 EMG 结果之间存在中度至高度一致性。MMT 是一种可靠的肌肉分级方法，但在某些临床情况下，针极 EMG 可能具有评估运动功能时存在 MUAPs 的价值。
