Spinal Cord Injury: ASIA Scale

Sensory screen supplies?

- cotton swab - pin prick

bottom line for ASIA A-E rankings?

They range from most severe/involved (A) to least (E)

Pinprick sensation patient Directions?

"Say 'Yes' if you feel the pinprick. If you feel pressure but no pin prick, say 'Dull.' If you do NOT feel anything, say 'absent.'"

Pt's file states "ND" for their SCI grading. How should PT interpret this?

- "Not Determined" - This means that the exam results aren't providing adequate information to document the sensory level, motor level, NLI, ASIA Impairment Scale Grade, and/or Zone of Partial Preservation.

anterolateral spinothalamic tract sensations

- Assessed via Pinprick (pain) - Use consistent pressure, poke only once! - Impaired = pt feels pressure, but can't discriminate the "sharp" touch

How is the ASIA scored?

- Both sides of the body get a motor and sensory score, which is added for a total score on each side - From these calculations, the pt has a SCI classification of A-E - Sensory: Cervical to Lumbar - Motor: MMT on 0-5 scale --> assess the 10 major muscle groups (UEs and LEs via myotomal levels) in supine

Key UE Muscles for SCI Motor Testing?

- C5 = Elbow flexion - C6 = Wrist extension - C7 = Elbow extension - C8 = finger flexors - T1 = 5th finger abductors

ASIA A

- Complete, the most involved - "Complete Injury" = ABSENT sensory (DAP) or motor (VAC) function in S4-5, with no sacral sparing (determined at S4-S5 dermatome)

Key LE Muscles for SCI Motor Testing?

- L2 = hip flexion - L3 = knee extension - L4 = ankle dorsiflexion - L5 = big toe extension - S1 = ankle plantarflexion

Motor Level

- LOWEST/most caudal myotome with MMT = or >3, provided that the muscles above this level are normal (MMT = 5) - For myotomes that aren't clinically testable (ex. C1-C4, T2-L1, S2-S5), motor level is the same as the sensory level

Incomplete Spinal Cord Injury

- Motor and/or sensory function present BELOW the neurological level that includes sensory and/or motor function at S4-S5, presence of sacral sparing

Which sensations does the DCML pathway consist of?

- Proprioception, vibration, light touch - Stroke each dermatome 1 cm length - C6-C8 - use dorsal surface of proximal phalanx - Chest and abdomen should be tested in the midclavicular line

Zones of Partial Preservation

- Pt has motor and/or sensory function below the neurological level but does NOT have sacral sparing - The areas with intact motor and/or sensory function below the neurological level = ZPPs - Sacral sparing = sensory function (DAP) or motor function (VAC) at S4-S5

ASIA B

- Sensory Incomplete, Motor Complete - Sensation intact, motor impaired below the NLI - Includes the sacral segments S4-S5 (light touch or pin prick present, or deep anal pressure present at S4-S5) AND no motor function is preserved more than 3 levels below the motor level on either side - Deep anal pressure (DAP) or VAC MUST be present - assess first time and then reassess a month later, condition can change from complete to incomplete

ASIA D

- Sensory Intact, Motor Incomplete - > ½ the key muscles below the NLI have a MMT grade > or = 3/5

ASIA C

- Sensory Intact, Motor Incomplete - VAC S4-5 present - >1/2 the key muscles (10 total) below the NLI are < 3/5 - OR, the patient meets the criteria for sensory incomplete (B = sensory function preserved at the most caudal sacral segments (S4-S5) and has motor function > 3 levels below the ipsilateral motor level on either side of the body - <1/2 of key muscle functions below the single NLI have a muscle grade ≥ 3/5 - Ex.) pt has 6/10 muscles that scored MMT < 3. Pt is an ASIA C spinal cord injury

ASIA E

- Sensory and Motor are Normal. - Pt has prior SCI deficits but sensation and motor function are normal in all segments - NOT given if pt doesn't have an initial SCI

3 steps to calculate Sensory Level?

- Test Light touch and pinprick on R and L sides at the key Dermatomes, record the scores - 0 = absent, 1 = impaired, 2 = normal - Determine Sensory Level (LOWEST/most caudal level where sensation is a "2" on both sides, providing the levels above are also "2s") - Test for presence of sensing Deep anal pressure (DAP) for S4-5. Recorded as "Yes" or "No"

how to calculate Motor Function?

- Test if Voluntary Anal Contraction (VAC) is "present" or "absent" - 5/5 = pt's pain decreases with active muscle contraction - (NT) = when pt has pain, spasticity, clonus or fracture

how to classify a spinal cord injury?

- determine sensory level (R/L) - Determine motor level = assessed via strength of 10 key muscles on R/L sides (MMT 0-5) - Determine the Neurological level of injury (NLI)

Proper testing manner for sensation?

- test on pt's face 1st - Test light touch, then pinprick - Responses are "Yes" if pt feels cotton swab, "No" if pt doesn't feel it, "Different" if pt feels something but it's not light touch

Neurological level of Injury (NLI)

- the LOWEST (most caudal) spinal segment with NORMAL sensation (ranked "2") AND at least 3/5 MMT strength on BOTH sides - Remember that the segments above must have NORMAL sensation ("2") & motor function ("5/5")

Sacral Sparing

S4-S5 - VAC Present? - DAP Present? - Light touch and pinprick present? If not, it's a COMPLETE SCI

What is the ASIA Scale?

System used to classify a SCI - examine dermatomes and myotomes at specific levels to find the NLI

Sensory tracts examined?

These are both AFFERENT pathways - Dorsal column Medial Lemniscal (DCML) - Anterolateral Spinothalamic (ALST)

How to grade sensory exam scale?

Used for light touch and pinprick 0 = none, 1 = decreased or abnormal sensation 2 = present NT = not tested

Pt positioning for MMT strength tests?

supine