ASIA Flashcards
ASIA is for patients older than __________
and should be performed __________ post injury
4 years old
72 hours
Light touch tests what column?
How is the patient positioned?
What pattern do you follow?
DCML
Supine
Rostral to Caudal, test all of one side first followed by the other side
What counts as a 1/2 for light touch
Patient reports being touched but it feels different than the control (face)
What column does pin prick test?
how to test?
How many correct answers is considered normal
Spinothalamic
Randomly alternate between sharp and dull 10 times
8/10
What is considered a 1/2 for sharp/dull testing
Patient can accurately distinguish between sharp/dull 8/10 times or more but reports it feels different than face
__________ Defines an incomplete spinal cord injury
Any anal sensation or voluntary anal contraction
________________ reliably predicted independent walking when performed 8-31 days after injury
Pin prick sensation at heel (S1)
L+R intact = 9/10 will independently walk
L or R = 8/10 will independently walk
Neither = 8/10 will not independently walk
C4: 2 C4: 2
C5: 2 C5: 2
C6: 1 C6: 1
C7: 1 C7: 0
What is the sensory level?
C5
The sensory level is the most caudal segment of the spinal cord with 2/2 for pin prick and light touch
What muscle groups correspond with C5, C6, and C7 on the ASIA scale
Elbow flexor
Wrist Extensor
Elbow Extensor
What muscle groups correspond with C8 and T1
Finger flexors to the middle finger
Small finger abductor
What muscle groups coorespond to L2, L3, and L4 on ASIA
Hip flexor
Knee Extensor
Ankle dorsiflexor
What muscle groups correspond to L5 and S1 on asia
Long toe extensor
ankle plantarflexor
How do you determine the motor level if the UE is intact, the LE is all 0s, and your sensory level is in the thoracic spine?
example: sensory level is T9
2/2 sensory = you assume motor is intact at that level aswell
so if the sensory level is T9 and there is no motor at L2-S1, you assume that the motor level is also T9
What is the motor level:
C5: 5
C6: 5
C7: 4
C8: 2
T1: 0
Motor level is C7, the motor level is the first score above 3 that has a 5 above it
Special rule for L2 and C5 motor level
Since there is no motor test for C4 and L1, you will assume these levels are 5/5 if they have intact sensory
So therefore if C4 Sensory is intact, and C5 motor score is a 3/5…
C5 is the motor level
How do you determine the neurological level in ASIA
Most caudal segment (lowest) with both normal motor and sensory bilaterally
Sensory Levels: R C4 L C3
Motor Levels: R C4 L C3
What is the neurological level?
C3
What is the motor level?
Motor:
C5: 3
C6: 0
C7: 0
C8: 0
T1: 0
Sensory:
C2: 2
C3: 2
C4: 2
C5: 2
C5
you assume that C4 motor is intact since sensory is 2/2, and therefore anything 3/5+ with a 5/5 behind it is your motor level
What is the skeletal level on asia?
The level that the greatest amount of damage is found on radiographic exam
How do you classify a patient as complete or incomplete on asia?
If they have N voluntary anal contraction, 0,0 on S4-S5 on both sides, N deep anal pressure = Complete
Anything besides the NOOOON sign = incomplete
What is sacral sparing?
preservation of either motor OR sensory function (or both) and must include the lowest sacral segments (S4/S5)
(Intact light touch/pin prick OR deep anal pressure or Voluntary anal sphincter contraction)
Pt has sensory function at S4-S5 bilaterally, but no motor function
ASIA B = sensory incomplete
Pt has no sensory or motor function at S4 S5 bilaterally
ASIA A = complete
Pt w/ a Neurological level of C6,
Motor levels:
C6: 5
C7:2
C8: 2
T1: 1
L2: 0
L3:0
L4:0
L5:0
…
S4/S5: 2
What is the ASIA classification
Motor incomplete (more than half of key muscles below neurological level are below 3/5)
Asia C
Pt w/ a Neurological level of C6,
Motor levels:
C6: 5
C7:4
C8: 4
T1: 3
L2: 3
L3: 3
L4: 2
L5 : 1
…
S4/S5: 2
What is the ASIA classification
ASIA D, Motor incomplete
Half or more muscles below the neurological level are greater or equal to 3/5
What is a pt’s ASIA score if all components of an exam are normal
ASIA E, normal
When is a ZPP, Zone of partial preservation used on ASIA?
Used only if no Sensory at S4/S5 and/or no motor at S4/S5
NOOOON
refers to the single most preserved sensory and motor segments that remain partially innervated
Can a pt with Voluntary anal contraction have a motor ZPP?
no
Can a pt with a voluntary anal contraction have a sensory ZPP
yes, depending on pin prick/light touch at S4/S5 (must be absent)
What is the sensory ZPP?
T12: 2
L1: 2
L2 :1
L3: 1
L4: 0
L5: 0
S1:0
S2: 0
S3: 0
S4-S5: 2
no ZPP
What is the sensory ZPP?
T12: 2
L1: 2
L2 :1
L3: 1
L4: 0
L5: 0
S1:0
S2: 0
S3: 0
S4-S5: 0
L3
What do we write on ASIA if something cannot be tested,
example: They have an amputation
NT: not tested
What do we add to an ASIA score if we believe that non-SCI conditions are contributing to that score
example: peripheral nerve injures, burns, chronic pain, age-related weakness
an asterisk
note: if you put an asteriks make sure you go back and explain in the comment box why
What percent of ASIA A ambulate?
ASIA B?
ASIA A: very little, 80% stay ASIA A, 20% convert to B or C and only 14% of those that convert will ambulate
ASIA B: 33%
What percent of ASIA C ambulate
ASIA D?
ASIA C: 75%
ASIA D: should recover and ambulate
In ASIA B patients, what is considered a predictive factor for ambulation
spared pin prick sensation
young age is a predictive factor
T or F: ASIA testing is the same as manual muscle testing
F, it is an assessment of intact nerves, not strength
What can be used as a substitute for deep anal pressure?
S3 pressure sensation
Where is C2 sensory tested?
At least 1 cm lateral to occipital protuberance at base of skull, or 3 cm behind ear
where is C3 and C4 tested?
C3 in supraclavicular fossa
C4 over AC joint
Where is C5 and C6 tested
C5: lateral side of antecubital fossa (Just proximal to elbow)
C6: Dorsal surface of the proximal phalanx of thumb
Where is C7 and C8 tested?
C7 Dorsal surface of proximal phalanx of middle finger
C8 Dorsal surface of proximal phalanx of little finger
Where is T1 and T2 tested?
T1: Medial side of antecubital fossa (just proximal to lateral epicondyle)
T2: Apex of axilla (armpit)
Where is T4 tested?’
T10?
T12?
Located at level of nipples
Located at level of umbilicus
Midpoint of inguinal ligament
Where is L1, L2, and L3 tested?
L1: MIdway between T12 and L2
L2: Anterior-medial thigh
L3 Medial femoral condyle above knee
Where is L4 and L5 tested?
L4: Medial malleolus
L5: Dorsum of foot at third MTP joint
Where is S1 and S2 tested?
S1: Lateral aspect of calcaneus
S2: Midpoint of popliteal fossa
Where is S3 and S4/5 tested?
S3: Ischial tuberosity
S4/5: Perianal area, less than 1 cm lateral to mucocutaneous junction
T or F: When preforming ASIA we should test both C5 myotomes, then both C6, then both C7..
F, should do all of one side then switch
ASIA C5 myotome
Elbow flexors
ASIA C6 myotome
Wrist extensors
ASIA C7 myotome
Elbow ext
ASIA C8 myotome
Finger flexors to MIDDLE FINGER at the DIP
Asia T1 myotome
Small finger abductor
ASIA L2 myotome
Hip flexors
ASIA L3 myotome
Knee extensors
ASIA L4 myotome
Ankle dorsiflexors
ASIA L5 myotome
Long toe extensors
ASIA S1 myotome
Ankle plantarflexors
Pt w/ last tested motor level at T1 at 5/5, pt sensory level at T11, what is the motor level?
T11
What 2 ways is motor level tested for C1-C4 on ASIA?
For T2-L1?
S2-S5?
C1-C4 sensory level and diaphragm
T2-L1 Sensory level and beevors sign (abdominal contraction)
S2-S5 sensory level and anal sphincter
What position does every muscle test take place in for ASIA?
SUPINE
If a pt cannot preform a 3/5 on an ASIA muscle test, what do we do next?
Test in scarecrow position for UE and ballerina position for LE for 2/5 or less
what do we assess before performing an ASIA muscle test?
assess ROM
also note: ALWAYS PALPATE MUSCLE YOU’RE TESTING
What is the common muscle substitution for C6 wrist extensors
Forearm supination and the use of gravity
what is the common muscle substitution for C7 elbow extensors
Externally rotating the shoulder, then quickly flexing the elbow and activating spasticity in triceps
palpation of triceps should be done during test
what is the common muscle substitution for C8 long finger flexors
Grade 1-3 involuntary movement of phalanx d/t wrist ext
Grade 4-5 use of hand intrinsic and flexor digitorum superficialis
When testing C8 motor level, where do we add resistance?
stabilize the MCP and PIP in extension, try to add resistance to the DIP!
what is the common muscle substitution for T1 small finger abductor
finger extension can mimic 5th finger abduction
What is the common substitution for L2 hip flexors?
Abdominal muscles elevating or rotating pelvis
What is the common substitution for ankle dorsiflexors?
Extensor hallicus longus
What is the common substitution for long toe extensors L5
Active plantarflexion or active flexion followed by relaxation may mimic extension
What is the common substitution for S1 ankle plantarflexors?
Pt may flex hip to bring heel off of mat
L2: 5
L3: 5
L4: 1
L5: 1
What is the motor level?
L3
How can a patient have motor incomplete status if they don’t have VAC?
If they have 3 levels of preserved motor function below their motor level on either side
Example:
Motor level: C7
Motor scores:
C5: 5
C6: 5
C7: 3
C8: 2
T1: 2
L2: 1
VAC: N
Pt has a motor level of C5, but has working elbow Pronators, finger extensors, and thumb abduction
Pt with no VAC
Motor incomplete,
Has 3 non-key muscle groups functioning below c5
Pt is a motor level of L2, but has hip adductors, hip extension, and hip external rotation
No VAC
Motor incomplete
Pt with 3 or more non-key muscle groups functioning below their motor level
Pt with a motor level of C6 , but also has working wrist flexors (C7)
No VAC
Sensory incomplete
Pt does not have 3 motor levels functioning below their official motor level
What specific muscle is tested for C5?
Biceps brachii, Brachialis
What specific muscle is tested for C6?
ECRL/ECRB
What specific muscle is tested for C7?
Triceps
What specific muscle is tested for C8?
Flexor Digitorum Profundus
What specific muscle is tested for T1?
Abductor Digiti Minimi
What specific muscle is tested for L2?
Iliopsoas
What specific muscle is tested for L3?
Quadriceps
What specific muscle is tested for L4?
Tibialis Anterior
What specific muscle is tested for L5?
Extensor Hallucis Longus
What specific muscle is tested for S1?
Gastrocnemius and Soleus
What factors are included in the prognostic walking CPR?
Age 65 or more? (Negative)
Motor score of L3
Motor score of S1
Light touch at L3
Light touch at S1
