ISNSCI exam (ASIA) Classification for SCI

How do you determine the neurological level of injury (NLI) for motor? (highest level that has both motor and sensory intact is what we want)

Lowest level with key muscle function of ≥ 3 (supine MMT) with all key muscles above graded 5.

What is a 2 for grading pin prick?

Normal- pt can distinguish between sharp/dull and reports sharp is the same as "normal" comparison

How do you determine the neurological level of injury (NLI) for sensory? (highest level that has both motor and sensory intact is what we want)

The most caudal, intact dermatome from both pin prick and LT. The dermatome level immediately above the first dermatome level with impaired pin prick or LT.

Exam should be performed in _________ with exception of side lying for rectal exam portion.

supine

What is the purpose of the ASIA exam?

- Determine sensory and motor neurological level - Use scores to characterize sensory/motor functioning - Determine completeness of injury for prognostic purposes

How to perform light touch sensory test for ASIA?

1. Wisp of cotton swiped ONCE over 1cm on face to use as a normal comparison-can swipe face again if pt needs reminder through out test 2. Swipe each key sensory point ONCE over 1cm area

Motor level is determined by the most caudal key muscle with at least _____ strength AND all rostral key muscles have 5/5 strength. In regions with no myotome to test, the motor level is assumed to be the same as the sensory level if the testable motor function above is also normal.

3/5

NT is given for motor testing if pt is unable to reliably test key muscle (immobilized; contracture of > ______ of ROM; severe pain; amputation).

50%

During ASIA exam, precautions should be taken for spinal instability. With suspected acute injury below T-___: no active or passive hip flexion >90 degrees. Exam is performed isometrically.

8

How do you determine if the patient has a complete SCI or incomplete SCI? can have sensory or motor incomplete

Based on presence ("sacral sparing") or absence of sensory and motor function at the S4-S5 level (NO anal contraction/pressure or no S4-5)

What is an ASIA A?

Complete no sensory or motor function is spared in S4-S5

What is step 5 of the ASIA classification?

Determine ASIA Impairment Scale (AIS) grade

What is step 4 of the ASIA classification?

Determine if injury is Complete or Incomplete- If voluntary anal contraction (VAC) = "No" AND all S4/5 sensory scores = "0" AND deep anal pressure (DAP) = "No", then injury is Complete. Otherwise it is Incomplete.

What is step 2 of the ASIA classification?

Determine motor level (R and L)- lowest key muscle function with grade ≥ 3 (in supine) with key muscle functions above intact (grade 5).

What is step 1 of the ASIA classification?

Determine sensory level (R and L)- most caudal (lowest) intact dermatome for both pinprick and light touch (LT).

What is step 3 of the ASIA classification?

Determine the neurological level of injury (NLI)- the most caudal level of the cord with intact sensation and antigravity (≥ 3) muscle strength with normal sensory and muscle scores rostrally.

What is step 6 of the ASIA classification?

Determine zone of partial preservation (ZPP)- ZPP is determined only for injuries with absent motor (no VAC) OR absent sensory function (no DAP, no LT, and no PP) in the lowest sacral segments S4/5.

What is a 1 for grading pin prick?

Impaired- pt can distinguish between sharp/dull but reports sharp is different than "normal" comparison from face

What is the ASIA C5 Motor exam?

MMT Elbow flexors = biceps brachii, brachialis

What is the ASIA C6 Motor exam?

MMT wrist extensors = ECRL, ECRB

What is an ASIA C?

Motor Incomplete motor function is preserved at most caudal segments on VAC OR patient is sensory incomplete with sparing of motor function more than 3 levels below motor level on either side of body (key or non-key muscles). For AIS C less than ½ key muscle functions below the NLI have a muscle grade ≥

What is an ASIA D?

Motor Incomplete motor incomplete status as above with at least ½ of key muscles below the NLI > 3/5 strength

If either NT or comorbidity results in an inability to determine motor level, sensory level, neurological level (NLI), AIS grade, or zone of partial preservation (ZPP), then "_____" should be placed in those boxes on the scoring sheet.

ND

If key sensory point or key muscle is not testable (pain, amputation, >50% ROM muscle contracture, etc) Then score = "_____" and should be tagged with an asterisk (*).

NT

What is an ASIA E?

Normal All components of the International Standards exam are normal Someone without a SCI does not receive an AIS score

Deep Anal sensation testing - if Light touch and Pin Prick are absent in ______, what does PT do?

S4-5 Digital exam of rectal wall; insert index finger and apply gentle pressure to anorectal wall (score Yes or No)

What is an ASIA B?

Sensory Incomplete Sensory but no motor function is present in S4-S5 AND no motor function preserved more than 3 levels below the motor level on either side of body

______________ is only for injuries with absent motor (no VAC - anal contraction) OR absent sensory function (no DAP, no LT, and no PP) in the lowest sacral segments S4/5. most caudal level with ANY innervation.

Zone of Partial Preservation (ZPP)

Spinal level of sensory impairment is determined by the most _______ double 2 of the score sheet.

cauda (closer to the top)

If a key sensory point or key muscle is effected by a __________ (preexisting or acute) to the SCI the numeric score should be accompanied with an asterisk (*)

comorbidity

What is a 0 for grading light touch?

does not report that swipe is felt

How to perform pin prick (sharp/dull discrimination) sensory test for ASIA?

open safety pin used, pointed end (sharp), rounded cap end (dull)- offer both on face as example of normal alternate sharp/dull on key sensory points in an "irregular nonpredictable manner" If you question reliability of pt report, you can test the segment with 10 repetitions (spaced out) and 8/10 correct considered accurate/intact

What is a 0 for grading pin prick?

pt does not report being touched or cannot discriminate between sharp and dull

What is a 2 for grading light touch?

pt reports swipe is felt and is the same as normal comparison

What is a 1 for grading light touch?

pt reports swipe is felt but differs from normal comparison