FF: SCI - ASIA Scale
determine AIS grade
5 grades (A, B, C, D, E) -A = complete -B, C, D = incomplete -E = normal
motor exam: common mm substitutions (S1)
hip flex in grade 3 position
determine ZPP
most caudal levels with some sensory or motor function below LOI -only scored when a pt has completely absent sensory in S4-S5 (no DAP, LT, and PP) OR when there is absent motor in S4-S5 (no VAC) -does not need scoring when sensory AND motor function in S4-S5 is present (put NA in all boxes)
AIS grades: C
motor incomplete -motor function preserved below NLI -LESS than half of key muscles below NLI have muscle grade ≥3/5
motor exam: determining motor score for levels with no muscles to test (C2-C4, T2-L1, S2-S5)
motor score determined from sensory score -two 2s at sensory level = 5/5 -two 1s at sensory level = <3/5 -asymmetrical at sensory level = <3/5
sensory exam
-28 key sensory points -LT and pinprick discrimination -face used as control -chest/abdominal points tested at midclavicular line -each point tested 5x
sensory exam: grading
-2: normal, same as cheek 5/5 times -1: impaired, different than touch of cotton on cheek (4/5 minimally impaired, 2-3/5 moderately impaired, 1/5 severely impaired; OR not same as cheek) -0: cannot reliably distinguish between being touched and not touched (0/5 times) -NT: unable to assess
motor exam: scoring
-3: full AROM, no resistance -4: full AROM, some resistance -5: full AROM, full resistance -2: full ROM no resistance (in exam-specific gravity eliminated position) -1: partial AROM or trace (palpable contraction) (in exam-specific gravity eliminated position) -0: no visible/palpable contraction (in exam-specific gravity eliminated position)
motor exam: key mm
-C5: elbow flex -C6: wrist ext -C7: elbow ext -C8: finger flex -T1: finger ABD -L2: hip flex -L3: knee ext -L4: ankle DF -L5: GT ext -S1: ankle PF
sensory exam: considerations
-asymmetrical results common -pt guessing...be consistent w wording
sensory exam: pinprick
-clean safety pin or pin in reflex hammer -each point 5x switching randomly between sharp and dull (aiming for consistent pressure) -ask for sharp/dull first, then if same as face -if pt feels something but can't differentiate between sharp/dull = 1
key considerations
-exam performed after spinal shock has resolved -motor plan your set up -testing performed in supine, true GE not used -full ROM must be achieved AG or GE -draping/pt privacy -be clear in explanations to get accurate score -concurrent injuries not related to the SCI are now scored (not assumed 5/5) -document and monitor
determining ZPP: sensory ZPP
-if pt has DAP present, put NA for for sensory ZPP on both R and L -if pt has absent DAP, but present S4-S5 LT or PP, then you put NA in R and L
what if pt has non-SCI related conditions?
-motor scores for concominant injuries are rated on same 0-5 scale with an asterisk* to indicate it is non-SCI related -ensures more accurate representation of pt's strength instead of false assumption of motor score
6 steps to determine AIS Grade
1. determine sensory level on R and L 2. determine motor level on R and L 3. determine single neurological level of injury 4. determine if the injury is complete or incomplete 5. determine ASIA Impairment Scale (AIS) grade 6. determine zone of partial preservation (ZPP)
motor exam
10 key mm examined (rostral to caudal) -move passively first to assess for contractures/tone/pain -no +/- in MMT grading for increased reliability/consistency -test at MMT grade 3 first
motor exam: common mm substitutions (T1)
5th finger ext can mimic ABD
motor exam: common mm substitutions (L5)
ankle PF watch for EHL tenodesis
motor exam: key mm innervated by
at least 2 roots; important for determining motor level! -only rostral root intact: strength will likely be 3/5 -both roots intact: strength will be 5/5
AIS grades: A
complete -no sensory and no motor function preserved in sacral segments S4-S5
determining if an injury is complete or incomplete
complete = no sensory or motor in S4-S5 (otherwise injury incomplete) -HINT: look for NOON sign
exam prep: tools
cotton swab safety pin ISNCSCI worksheet
sensory exam: light touch
cotton tip applicator -test no >1cm at a time (no sweeping) -each point 5x
sensory exam: deep anal pressure
digital rectal exam; can be done in sidelying -pt asked to report awareness -scored as present/absent
sensory exam: determining sensory level
done for R and L sides -where sensory function is normal for both LT and PP -HINT: look for the last two 2s
motor exam: determining motor level
done for both R and L sides -level at which strength is ≥3/5 with all levels above being 5/5 -HINT: look for string of 5s above
motor exam: common mm substitutions (C6)
forearm supination, must support elbow properly
determining ZPP: motor ZPP
if pt has motor function (VAC present) -NA in motor ZPP boxes for R and L
determining neurological level of injury
most rostral of the 4 sensory and motor levels -not always a good predictor of functional capacity
AIS grades: D
motor incomplete -motor function present below NLI -half or MORE of key muscles below NLI have muscle grade ≥3/5
AIS grades: E
normal -sensory and motor function is normal (SCI is present but neurological deficits are undetectable)
sensory exam: perianal area (S4-S5)
position in frog leg (supine w hips in slight ABD/ER and knees flex) -test LT and pinprick 5x with long swab (no pin!) -deep anal pressure
AIS grades: B
sensory incomplete -sensory function present at S4-S5 -no motor function below neurological level of injury (NLI)
motor exam: common mm substitutions (C7)
shoulder ER rebound elbow flex
exam prep: testing position
supine/anatomical position
sensory exam: if unsure of pt's anwers
test point 10x -(8/10 correct is standard for accuracy)
motor exam: common mm substitutions (L4)
toe ext can mimic ankle DF
motor exam: perianal exam
voluntary contraction -scored as yes/no
motor exam: common mm substitutions (C8)
wrist ext watch for tenodesis
