Validation of the Corticospinal Activation Protocol for Spinal Cord Injury Rehabilitation- A Delphi Consensus Study

Abstract

Sharanjeet Kaur, Narkeesh Arumugam and HS Chhabra

Study Design: Descriptive Study (Phase I: Delphi Consensus Study, Phase II: Pilot Trial).

Objectives: To formulate a novel CAP for incomplete SCI and evaluate its content, face, construct, and criterion (concurrent and preliminary predictive) validity through expert consensus and pilot clinical testing.

Settings: Neuroots- Neurorehabiliation Unit in Patiala, Punjab, India and Department of Physiotherapy, Punjabi University, Patiala, Punjab (India).

Methods: CAP was formulated via a comprehensive literature review, development of a multidomain conceptual framework (motor, sensory, autonomic, cognitive, vocational), and stakeholder consultation with individuals with SCI and clinicians. Content and face validity were established using a Delphi consensus process with a multidisciplinary expert panel rating item relevance, clarity, and essentiality and providing qualitative feedback. Construct validity was examined by correlating CAP domain scores with established neurophysiological and clinical measures (e.g. motor and somatosensory evoked potentials, autonomic function scales, ASIA lower limb scores, WISCI II, SCIM III). Criterion validity was explored in a pilot study including two small groups of individuals with traumatic, incomplete thoracolumbar SCI, comparing CAP with activity-based therapy plus conventional physiotherapy over a 30-day intervention.

Results: Experts demonstrated near perfect agreement on CAP item relevance and essentiality, indicating strong content validity, and qualitatively endorsed the protocol as relevant, comprehensive, and aligned with neuroplasticity driven, functional rehabilitation. CAP domain scores showed moderate to strong convergent correlations with corresponding neurophysiological and functional reference measures, supporting construct validity. In the pilot study, participants receiving CAP exhibited greater improvements across electrophysiological indices, locomotor capacity, functional independence, and autonomic function than those receiving standard therapy, providing preliminary evidence of concurrent and predictive criterion validity.

Conclusion: The Corticospinal Activation Protocol is a theoretically grounded, stakeholder informed, and psychometrically supported framework for rehabilitation in incomplete SCI. CAP addresses important limitations of non-standardized activity based and conventional physiotherapy and offers a structured platform for standardized clinical implementation and future multicenter trials.

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