Study design: Prospective repeated measures.
Objectives: Evaluate intra-rater agreement of repeated motor and sensory scores at individual spinal levels.
Setting: Non-profit pediatric rehabilitation center.
Methods: Fifty-eight youth with complete spinal cord injury undergoing two neurological exams. Agreement between exams for each myotome and dermatome was evaluated for four neurological groups: C1-C4 (N=9); C5-C8 (N=8); T1-T6 (N=22); T7-T12 (N=19). Kappa (k) and weighted k (k(w)) coefficients were calculated.
Results: Agreement between strength scores was 99 and 100% in subjects with tetraplegia and paraplegia, respectively. C1-C4: pin prick (PP)=absolute agreement (AA) in 57% dermatomes (D) (k range=0.10-0.83; k(w) range=0.36-0.93). Light touch (LT)=AA in 59% D (k range=0.35-0.77; k(w) range=0.34-0.84). C5-C8: PP=AA in 86% D (k range=0.28-0.78; k(w) range=0.43-0.93). LT=AA in 80% D (k range=0.10-0.80; k(w) range=0.12-0.91). T1-T6: PP=AA in 82% D (k range=0.36-0.83; k(w)=0.20-0.96). LT=AA in 77% D (k range=0.23-0.89; k(w) range=0.23-0.89). T7-T12: PP=AA in 82% D (k range=0.46-0.90; k(w) range=0.54-0.90). LT=AA in 84% D (k range=0.41-0.87; k(w) range=0.52-0.94).
Conclusion: Overall, agreement was excellent for myotome comparisons. For the C5-C8, T1-T6 and T7-T12 groups, there are variations in sensory scores within three levels of the neurological level (NL). For the C1-C4 group, variation in sensation extended well caudal to the NL. The International Standards for Neurological Classification of Spinal Cord Injury is a good outcome measure for a single-site, one-rater study but differences in repeated sensory scores at individual D were found, which should be considered in the interpretation of results of outcome studies.