ASIA Flashcards
What is the function and decussation of the corticopsinal tract
Motor (descending)
Spinomedullary junction
What is the function and decussation of the DCML
Light touch and proprioception
Within the medulla
What is the function and decussation of the spinothalamic tract
Pain and temp (ascending)
Crosses at various levels within SC
What do u loss with a complete transverse cord dysfucntion
- motor on both sides
- pain , temp on both sides
- fine touch , vibration , pressure , proprioception both sides
What do u lose and spare with a incomplete Central cord dysfucntion
- motor on both sides
- pain , temp on both sides
- find touch , bivration , pressure , proprioception both sides
- spare sacral
What do u lose with an incomplete anterior cord dysfucntion
- motor on both sides
- pain , temperature on both sides
What do u lose with an incomplete posterior cord dysfucntion
-fine touch , pressure , vibration , proprioception on both sides
What do u lose with an incomplete brown sequard cord dysfucntion
- pian and temp contralterally
- fine touch , pressure , vibration , propricoetopn ipsilateral
- motor ipsilaterlly
What is the use of the International Standards for Neurologic Classification of Spinal Cord Injury (ISNCSCI)
- standardized measure of neurological damage across the continuum
- establish a common measure of effectiveness
- facilaitre communication of reliable clinical data between PT and researchers
- measure progress
- establish a patient prognosis
Where is T1 and T2 sensory testing points at for ASIA
T1: on medial side of elbow
T2: apex of axilla
Where is T3-T6 sensory testing points at for ASIA
T3: midclavicaulr line and the third intercostal space ,
T4: midclavicular line and the 4th intercostal space , level of nipples
T5: located midway between level of nipple and level of xiphisternum
T6:midclavicular line , located at the levle of xiphisternum
Where is T10-T12 sensory testing points at for ASIA
T10: levle of ummbilicus
T11: midway between belly button and inguinal ligament
T12: over the midpoint of inguinal ligament
Where is L2-L3 sensory testing points at for ASIA
L2: anterior medial thigh
L3: medial femoral condyle above the knee
Where is S1 and S2 sensory testing points at for ASIA
S1: lateral aspect of ankle
S2: midpoint of popliteal fossa (behind knee)
Where is S3 and S4/5 sensory testing points at for ASIA
S3: over ischial tuberosity
S4/5: in the perianal area
What will anorectal exam determine
Sensory and motor sparing at the lowest level of spinal cord
What nerves innervate the external anal sphincter
Pudendal nerves
S4-S5 somatic sensation
S2-S4 somatic motor
Any anal sensation or voluntary anal contraction define what kind of spinal cord injury
Incomplete
how do u know if the deep pressure in the anorectal exam is incomplete
Incomplete if no pin prick or light touch sensation was present
Test 3 pressures
How do u check deep anal pressure
Apply gentle pressure to anorectal wall with index finger or use thumb to gently squeeze tissue against inserted index finger
What can be used for predication deep anal pressure in the 1st month post injury
S3
How is independent walking defined as for SCI
Ability to walk 1 block outdoors vs 150 feet inside
If people have normla left and right lateral heel pinprick sensation how likely is it that they will walk
9/10
If someone has ANY left or right lateral heel pinprick sensation what is the outcome of walking
8/10
If someone have NO L or R lateral heal pinprick sensation how likely is it they wont walk
8/10
What defines the sensory level in the ASIA
Most caudal segment of the spinal cord with “normal” (grade 2) sensory function (both sharp/dull and light touch)
What is considered a normal sensory level grade
2
if sensation is abnormal at C2 assume what is the sensory level
C1
So if someone has T2 level of 2’s and then at T3 there is a 2 and 1 what is the sensory level
T2
What are the 2 optional sensory examination for ASIA
Joint movement appreciation and deep pressure appreciation
How do u pressure the joint movement appreciation (kinesthesia)
- grab limb distal to the joint being tested on the medial and lateral aspects
- alternate direction of movement beginning from the mid position
- ask the patient to state when movement is perceived and the direction
How do u perform the deep pressure appreciation
- apple firm pressure for 3-5 secs
- have patient indicate when pressure is felt and any feelings when pressure is not being applied
What are the 10 key motor levels for ASIA
C5- elbow felxin
C6- wrist extension
C7- elbow extension
C8- finger flexion
T1- finger abductors
L2- hip flexors
L3- knee extensors
L4- ankle DF
L5- long toe extension
S1- ankle PF
What is the motor exam graded on
6 points scale with 2 additional consideration
What is the positioning for the motor exam for ASIA
Supine position
Should u alternate sides while examining motor ?
No do one side first then the other
What are the grades for motor ASIA exam
0- total paralysis
1- palpable or visible contraction
2- full range of motion , no assistance in gravity reduced
3- full ROM , no resistance within gravity
4. Full ROM against moderate resistance
5. Normal full ROM against full resistance
What is the 4 criteria that the key mm were chosen based on
1) A muscle action was needed to represent each of the respective spinal cord segments
2) Each muscle action had to have functional significance
3) Each muscle function had to be accessible in the supine position
4) Innervation from at least 2 spinal segments
What are the key mm for C5-T1
C5: Biceps, brachialis
C6: Extensor carpi radialis longus and brevis
C7: Triceps
C8: Flexor digitorum profundus to the third digit
T1: Abductor digiti minimi
What are the key mm for L2-S1
L2: Illipsoas
L3: Quadriceps
L4: Tibialis anterior
L5: Extensor hallucis longus
S1: Gastrocnemius, soleus
Motor follows sensory in areas u cant test .. waht are the areas
C1-C4
T2-L1
S2-S5
t/f: motor presumed same as sensory so if sensory is intact so is motor
T
How should u conduct the exam for motor examination in ASIA
- examine key mm rostral to caudal on one side of the body frist
- move thur the avaiable ROM to detect contractures , spasticity or pain
- palpate the tested mm
- test for grade 3 frist then more up or down the scale accordingly q
A common mm subsitiotns of C6 wrist extensors can be mimicked by what
Forearm supination and the use of gravity
A common mm substitution for C7 elbow extensors can be mimicked by
Externally rotating the shoulder, by quickly flexing the elbow and then relaxing , and with spacisity of the triceps
Grades 1 through 3 of C8 long fingers flexors can have a common mm substitution thru what
Involuntary movement of the distal phalanx can occur int he presence of active wrist extension (tendesis)
Grades 4 through 5 of C8 long fingers flexors can have a common mm substitution thru what
Distal phalanx movement causes by contraction of the hand intrinsics or the flexor digitorum superficialis
What is a common mm substitution for T1 small finger abductor
Finger extension can mimic 5th finger abduction
What are common mm substitution for L2 hip flexors
Abdominal mm can elevate or rotate the pelvic
make sure u palpate
What is a common mm substitution for L4 ankle DF
Can be mimicked by great toe extension , especially extensor hallucis longus
What is a common mm substitution for L5 long toe extensors
Passive great toe extension may occur w active PF
Active flexion of the great toe followed by relaxation .. passive relaxation may be interpreted as active extension
What is a common mm substitution for S1 ankle PF
In an against gravity position , patient may flex his hip to bring heel off the mat
The voluntary anal contraction is testing what
External sphincter S4-S5
How is the patient positioned and what do u do for. A voluntary Anal contraction for anorectal exam
In SL
Insert gloved and lubriacted finger into anus and ask patient to use their mm as if they are trying to hold back bowel movement
What is a good motor performance for testing VAC in patients with injuries at T10 and above
hip adductors and toe flexors
what is the scoring for motor examination for ASIA
The lowest level of key muscle that has a 3,4 or 5 with a 5 above at the mm level above
T/F: motor levels can be different from right and left
True
How do u score for the myotomes that are not clinical testable during the motor exam during ASIA ( C1-C4, T2-L1, S2-S5)
If the motor function above these levels are normal , the motor level will be the same as the sensory level … if sensation is impaired , then the motor function is considered imparied too
What is the special rules for C4 and L2 for the motor examination scoring
If C5 is less then 2 then the sensation at C4 is used as a subsitute motor function
For L2 if it is less then 2 , the sensation at L 1 is used
**if the C5 is a 3 and then the sensory is 2’s at C5 then the motor level is C5
How do u know what the neurological level is for the ASIA exam /…. ‘’Say the right is C3 and the L is C5 what is the level
The lowest segment with both normal motor and sensory bilaterally
So if the R is C3 and the L is C5 then the level is C3 bc that’s where they are both normal
What is the classification of a complete injury defined as
Absence of sensory (light touch , pin prick , or deep pressure) and the motor function (voluntary anal contraction) at S4/5 (NOOOON)
What is the classification of a incomplete injury defined as
Partial preservation of sensory and/or motor function at S4/5
So pateint has deep anal pressure prob
What is included with sacral sparing
Intact light tough or pin prick at S4/5 (sensory)
Or
Deep anal pressure (sensory)
Or
Voluntary anal sphincter contraction (motor)
What is AIS A - complete injury
No sensory or motor function is preserved in the sacral segments S4-S5
What is AIS grade B
Sensory incomplete
Sensory , but no motor at S4-S5
What is AIS C
Motor incomplete
More then half of key mm below the neurological level of injury have a grade less then 3
What is AIS D
Motor incomplete
Half or more of key mm below the neurological level or injury have a grade greater than or equal to 3
What is AIS E
Normal
What is preserved at AIS C
Motor function is preserved at S4-S5 (voluntary anal contraction or patient meets criteria for sensory incomplete status and has sparing of motor function more than 3 levels below the motor level on either side of the body
If there is no sacral sensation at S4-5 , DAP or VAC what ASIA classification are they
AIS A
If the patient has sacral motor preservation and there is motor return > 3 levels below motor level what and then u realize they have 50% or more key mm below the neurological level greater then or equal to 3
AIS D
If the patient has sacral motor preservation and there is no motor return > 3 levels below motor level what is the ASI score
B
If the patient has sacral motor preservation and there is motor return > 3 levels below motor level what and then u realize they dont have 50% or more key mm below the neurological level greater then or equal to 3
AIS C
Is patient has a sensory preserved in sacral segments AND has motor return >3 levels below ipsilateral motor level on either side of the body what score is it ? (Included key and non key mm function )
AIS C
What is the zones of partial preservation
Refers to the single most preserved sensory and motor segments on each side that remain partially innervated
When is zone of partial preservation used
Only with absent motor (no VAC) and/or absent sensory function (no S4-S5 LT/PP sensation AND no DAP)
What do u record for the zones of partial preservation
Lowest segment in both sensory and motor (can be any sensory or motor grade )
When is sneosry ZPP not applicable
If sacral sensory function (S4/5 LT , PP) is present
When is motor ZPP no applicable
If voluntary anal compression is present
how are abnormal exam scored targeted w and what does it indicate
Asterisks to indicate that a non SCI condtion impacts the results
(Ie; amputees)
What is a change of ambulation for AIS A-D
A: very little
B: 33%
C: 75%
D: should recover
Is ASIA scoring a MMT TEST? Why or why not
No , it is an assessment of intact nerves innervation and not strength
Who is the International Standards for Neurologic Classification of Spinal Cord Injury (ISNCSCI) reliable for and when should it be performed
reliable for subject older than 4 years of age
Should be performed at 72 hours post injury to compare with subsequent exams
What subscores does teh International Standards for Neurologic Classification of Spinal Cord Injury (ISNCSCI) recommend
Use of upper and lower extremity sub score instead of the total motor score
What is the steps in classicaiton of the ASIA score
- Detemine the sensory levels for L and R sides
- Determine motor levels for L and R sides
- Determine the neurological level of injury
- Determine whether the injury is complete or in complete
- Determine ASIS impairment scale grade … is injury complete if yes = A if no is the injury motor complete if yes then B if no then are at least half or more of the key muscles below the neurological level of injury graded 3 or better if no then C if yes then D
- Determine the zone of partial preservation
What are the 2 parts of the ASIA sensory examination
○ 1) Light Touch Appreciation
○ 2) Sharp/Dull Discrimination (Pin Prick
What is the standardization of testing for ASIA sensory examination
-always test in supine
- rostral to caudal assessment of key sensory points in each dermatome
- examine all key senosyr points sequentially on one side of the body then do the other side
- pateints eyes should remain close during testing
How many key sensory points are there
28
(C2-C8 , T1-T12, L1-L5, S1-S4/5)
What pathway does light touch appreciation in ASIA
DCML
What is used as a reference of normal light touch
Face
What is the light touch grading for the ASIA
0- absent
1- impaired
2- normal
NT- not testable
What tract does sharp/dull discrimination do
Spinothalamic tract
Where is C2-C4 sensory testing located
C2- lateral to occipital protuberance at the base of the skull, alternately is can be located at least 3 cm behind the ear
C3: supraclavicualr fossa at mid clavicaulr line
C4: over the AC joint
Where is C5-C8 sensory testing locations at
C5: lateral elbow
C6: dorsal surface of prox phalanx of thumb
C7: dorsal surface of prox phalanx of middle finger
C8: dorsal surface of the prox phalanx of the little finger
C5: lateral elbow
C6: dorsal surface of prox phalanx of thumb
C7: dorsal surface of prox phalanx of middle finger
C8: dorsal surface of the prox phalanx of the little finger
