ASIA Flashcards
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special rule for C5 or L2 if they are the first weak key muscle…
C5: sensation at C4 2/2 is used as substitute for motor
L2: sensation at L1 2/2 is used as substitute for motor
Definition of the neurological level
the most caudal segement with BOTH normal motor and sensory bilaterally is neurological level
The level at which, by radiographic exam, the greatest
vertebral damage is found
skeletal level
absence of sensory and motor function at S4/5
No light touch, pinprick, DAP, VAP
NOOOON COMPLETE ASIA A
partial preservation of sensory and/or motor function at S4/5: ASIA LEVELS
INCOMPLETE
ASIA B-D
preservation of sensory or motor function below the level of injury, and must include the lowest sacral segments
sacral sparing
*intact light touch or pin prick at S4-5
OR
*DAP
OR
*VAC
ASIA B Classification criteria
- sensory is preserved S4/5 (light touch, pinprick, OR DAP)
2.** NO MOTOR FUNCTION is preserved more than 3 levels below motor level on either side of body**
SENSORY INCOMPLETE
ASIA C classification criteria
- motor function at S4/5 (VAC)
- OR patient meets criteria for ASIA B and has motor function spared MORE THAN 3 LEVELS below motor level on either side of body includes key and non-key mm
*4. at least half of key mm function below neurological level of injury have mm grade of <3 (0, 1, 2)
MOTOR INCOMPLETE
ASIA D classification criteria
- motor function at S4/5 (VAC)
- OR patient meets ASIA B criteria and has sparing of motor function *more than 3 levels below the motor level *on either side of the body, includes key and nonkey mm
3.** at least half of KEY MM below the neurological level of injury have mm grade of 3+ (3, 4, 5)**
MOTOR INCOMPLETE
Can a patient have sacral sensory intact (DAP, S4/5), no sacral motor preservation (VAC), but still classify for ASIA C or D?
YES, BACK DOOR METHOD
no VAC, but is there motor preserved more than 3 levels below the MOTOR level?
If over half of key mm below neuro level of injury are 0, 1, 2 –> C
If over half of key mm below neuro level of injury are 3+ –> D
ASIA E classification
sensory and motor function are normal in all segments, patient had prior deficits
differences between ASIA B and C
B: sensory function in sacral segments(S4/5 LT, PP, OR DAP) and no VAC, no motor function >3 levels below the motor level
C: VAC present
OR sensory function in sacral segments (S4/5 LT, PP, OR DAP) AND motor return >3 levels below ipsi motor level on either R or L side, including non-key mm!
When is ZPP used in ASIA?
- no VAC
AND/OR - No S4/5 LT/PP sensation AND no DAP
*NOOON or absent VAC or 0000 no DAP
Refers to the single most preserved sensory and motor segments on each side that remain partially innervated
ZPP zone of partial preservation
if S4/5 LT/PP is present, then is sensory ZPP applicable?
NO, mark N/A
If VAC is present, is motor ZPP applicable?
NO, mark N/A
If key mm or dermatomes (NT) cannot be tested,
can you still determine ASIA grade?
can you still determine ZPP?
can you still determine total score for sensory, motor, neuro levels?
NO
record as ND (not defined)
What does the astericks mean? *
abnormal scores, either motor or sensory indicating NON-SCI CONDITION impacting results
*above, at or below the level
must provide “comments”
- an astericks above the sensory/motor level are handled as normal during ASIA classification: T or F
TRUE
astericks* below the sensory/motor level are handled as normal during ASIA classification: T or F
FALSE, handle as NOT NORMAL
ASIA A: chance of ambulation
very little
*80% remain A
*10% conver to B
*10% convert to C
of those converting to B or C, only 14% regain ambulation, and mm 1 or 2 at 1 month will become 3/5 one year after injury
ASIA B: prediction of ambulation
33%
predicted by spared pinprick sensation
young age also is predictive
ASIA C: prediction of ambulation
75%
higher chance with low T or lumbar level injury
ASIA D prediction of ambulation
should recover and ambulate
Brown Sequard syndrome
contra PP/temp loss
ipsi DCML, motor loss
ipsi autonomic, nerve root pain
*ipsi LMN weak at LOI
Posterior cord syndrome
bilateral DCML loss
*syphilis
anterior cord syndrome
bilateral motor loss
bilateral Pain, temperature loss
central cord
Cape distribution
segmental weakness, atrophy of hands/arms with loss of DTRs
OR
*sacral sparing, loss of everything both sides (motor, Pain, temp, DCML)
*syringomelia, cervical hyperextension
complete spinal cord injury is known as
transverse cord
loss motor, pain/temp, DCML both sides
