Basecamp: SCI and ASIA Impairment Scale

What is the ASIA Impairment Scale?

A scale that grades the degree of impairment and severity of injury of a patient.

Where do extension injuries usually occur?

C4-C5

Anterior Cord Syndrome

- caused by flexion injuries - occurs when 2/3 of the anterior cord is lost - *motor function, pain, and temperature sensation lost bilaterally below the lesion* (*flaccidity* below the lesion) - injuries the spinothalamic and corticospinal tracts

Cauda Equina Syndrome

-Injury at the L1 level and below resulting in a LMN lesion (peripheral nerve injury) -Flaccid paralysis, areflexia, impairments in bowel and bladder Full recovery not typical

A spinal cord injury that presents with no sensory or motor function found in sacral segments S4-S5 is classified as: A B C D

A Class A on the American Spinal Cord Injury Association (ASIA) scale is characterized by a complete transection of the spinal cord in which motor and sensory function is absent at the S4 and S5 segments.

What are the different grades of the ASIA Impairment Scale?

A - Complete B - Sensory Incomplete C - Motor Incomplete (less function) D - Motor Incomplete (more function) E - Normal

What is the motor level of an SCI?

A level determined by the most caudal key muscles that have strength 3 or greater with the immediately superior segment tested as normal or 5

A spinal cord injury in which motor function is preserved and more than half of the muscles below the neurological level have a muscle grade of less than 3/5 would be classified as: A B C D

C Class C on the American Spinal Cord Injury Association (ASIA) scale is characterized by preservation of motor function below the neurological level with less than half of the muscles below the neurological level having a muscle grade of less than 3/5.

What are the key muscles tested for C5-8, T1, and L2-S1

C5 - Elbow Flexors C6 - Wrist extensors C7 - Elbow extensors C8 - Fingers 1-3 flexors T1 - Small finger abductors L2 - Iliopsoas L3 - quad L4 - DFs L5 - Long toe extensors S1 - PFs

Where do flexion injuries usually occur?

C5-C6

ASIA Impairment level A

Complete - No sensory or motor function is preserved in sacral segments S4-S5

What are the two types of general SCI?

Complete (no motor or sensory below) and incomplete (scattered function below)

What is the Sensory Level of an SCI?

Determined by the most caudal dermatome with a normal score of 2/2 for pinprick and light touch

(T/F) The ASIA Impairment scale is used during the systems review

False - Tests and Measures

What are the key locations for sensory testing of light touch and pinprick for C2-S5?

Graded as: 0 = absent 1 = impaired/hyperesthesia 2 = nintact

Brown-Sequard Syndrome

Hemi-section of the cord - ipsilateral spastic paralysis and loss of position sense (injury to the Corticospinal tract and Dorsal Colum) - contralateral loss of pain and thermal sense (injury to the lateral spinothalamic tract)

What is the most common cause of a spinal cord injury?

MVA

What often dictates the type of SCI?

Mechanism of injury

ASIA Impairment level C

Motor Incomplete - Motor function is preserved for voluntary anal contraction, OR the patient meets "sensory incomplete" status and has more than 3 levels of motor function below the motor level on either side of the body. In this level LESS than half the key muscle functions below the neurologic level have a muscle grade of greater than or equal to 3

ASIA Impairment level D

Motor Incomplete 2 - "motor incomplete" status as defined with at least half or more than half of the key muscles functioning at a grade of 3 or more below the neurologic level of injury.

Posterior Cord Syndrome

Relatively rare injury that can occur due to compression of the posterior spinal artery. Results in a loss of dorsal columns bilaterally, bilateral loss of proprioception, vibration, pressure, stereognosis, 2 point discrimination; With preservation of motor function, pain and light touch;

ASIA Impairment level B

Sensory Incomplete - Sensory function is preserved below the neurologic level, including S4-S5 AND no motor function is preserved more than 3 levels below the motor level on either side of the body

ASIA Impairment level E

Sensory and Motor Functions are normal in a patient that had prior deficits

What is the Motor Index Scoring for an SCI?

Testing each key muscle using the 0-5 scoring with total points of 25 per extremity for the total possible score of 100

According to the ASIA classification of spinal cord injury, what are the key muscles for the C5 level? elbow flexors wrist extensors elbow extensors finger flexors

elbow flexors According to the ASIA classification of spinal cord injury, the key muscles for the C5 level are the elbow flexors. Muscles receiving innervation at the C5 level that flex the elbow include the biceps brachii, brachialis, and brachioradilais.

According to the ASIA classification of spinal cord injury, what are the key muscles for the L5 level? hip flexors knee extensors ankle dorsiflexors great toe extensors

great toe extensors According to the ASIA classification of spinal cord injury, the key muscles for the L5 level are the great toe extensors. Muscles receiving innervation at the L5 level that extend the great toe include the extensor hallucis longus.

According to the American Spinal Injury Association (ASIA) classification of spinal cord injury, the most caudal level with normal motor and sensory function on both sides of the body describes the: zone of partial preservation sensory level neurological level motor level

neurological level According to the American Spinal Injury Association (ASIA) classification of spinal cord injury, the most caudal level with normal motor and sensory function on both sides of the body is the neurological level.

Which of the following describes a patient classified at level E on the ASIA Impairment Scale? no motor or sensory function sensory, but no motor function motor, but no sensory function normal motor and sensory function

normal motor and sensory function The American Spinal Injury Association (ASIA) Impairment Scale divides spinal cord injuries into 5 categories, with optional clinical syndromes. According to the scale, A = a complete lesion and E = normal.

Central Cord Syndrome

occurs with compression and damage to the central cord, usually as a cervical hyperextension. Symptoms include weakness or paresthesia in the upper extremities greater than the lower extremities and greater motor deficits as opposed to sensory.

What type of damage can occur in the SC?

primary (initial trauma) and secondary (extension of injury down the cord)

How is the T1 myotome best assessed according to the ASIA Impairment Scale? resist little finger adduction resist little finger abduction resist finger flexors resist finger extensors

resist little finger abduction Each of the spinal nerves controls certain muscles. The muscles controlled by a particular nerve root are called its myotome. The T1 myotome is best assessed by resisting little finger abduction.

According to the ASIA classification of spinal cord injury, what are the key muscles for the C6 level? elbow flexors wrist extensors elbow extensors finger flexors

wrist extensors According to the ASIA classification of spinal cord injury, the key muscles for the C6 level are the wrist extensors. Muscles receiving innervation at the C6 level that extend the wrist include the extensor carpi radialis longus, extensor carpi radialis brevis, and extensor carpi ulnaris.