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Neuro Rehab 2 > SCI - 2 ASIA > Flashcards

SCI - 2 ASIA Flashcards

1
Q

international standards of neurologic classification of SCI (ISNCSCI) vs ASIA

A

ISNCSCI: measures extent of neurologic injury following a SCI

ASIA: categorizes degrees of injury into different groups

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2
Q

what are the 6 steps for classification of SCI

A
  1. sensory R/L
  2. motor R/L
  3. neurological level of injury (NLI)
  4. complete or incomplete
  5. ASIA
  6. zone of partial preservation
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3
Q

how do you determine if someone is complete vs incomplete

A

if there is any sacral sparing in sensory/motor function of S4-5

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4
Q

what is the most important predictor of recovery

A

zone of partial preservation

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5
Q

what are the corresponding SC tracts tested during the sensory exam of the ASIA

A

pinprick = lateral spinothalamic

light touch = anterior spinothalamic, dorsal column

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6
Q

how is the most caudal sensory level determined in the ASIA

A

most caudal, normally innervated dermatome for both pinprick (sharp/dull discrimination) and light touch
- score = 2

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7
Q

how were the key ms groups chosen in the ASIA

A

nerve group that innervates the ms group w the most significant impact on function

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8
Q

what are the the 5 UE key ms groups for the ASIA motor exam

A

C5 = elbow flexors
C6 = wrist ext
C7 = elbow ext
C8 = finger flex
T1 = 5th finger ABD

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9
Q

what function do C5 key ms support

A

eating

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10
Q

what function do C6 key ms support

A

tenodesis grip
- use of wrist ext to automatically flex fingers

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11
Q

what function do T1 key ms support

A

open fingers to hold objects

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12
Q

what are the 5 LE key ms groups for the ASIA motor exam

A

L2 = hip flexors
L3 = knee ext
L4 = ankle DF
L5 = long toe (2nd digit) ext
S1 = ankle PF

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13
Q

what function do the LE key ms groups support

A

mobility and ambulation

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14
Q

what are 6 considerations for the ASIA motor exam

A
  1. check available ROM
  2. stabilize prox
  3. consistent use of supine
  4. LE gravity eliminated position (45deg hip flex and full ER)
  5. ms substitutions
  6. spasticity and/or contractures
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15
Q

what is a grade of 5* on the motor exam of the ASIA

A

use clinical judgment
- pt has fx and anticipating when it heals, they will have function of ms

limitations secondary to another issue, not the SCI

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16
Q

what ms substitution should you watch for when testing for the triceps in a motor exam

A

shoulder ERs

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17
Q

what ms substitution should you watch for when testing for the finger flexors in a motor exam

A

a tenodesis grasp

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18
Q

what ms substitution should you watch for when testing for the finger ABDs in a motor exam

A

finger ext

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19
Q

what ms substitution should you watch for when testing for the ankle DFs in a motor exam

A

long toe extensors

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20
Q

what ms substitution should you watch for when testing for the great toe ext in a motor exam

A

PFs

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21
Q

what is the ASIA’s ms grading (which is different from MMT)

A

0 = absent
1 = visible or palpable contraction
2 = ms move thru full ROM in GM at least 1x
3 = ms can move thru full ROM AG at least 1x
4 = able to perform full ROM AG and some resistance
5 = able to perform full ROM AG and “normal” resistance

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22
Q

what is a neurological level of injury (NLOI)

A

most caudal level of SC that exhibits intact sensory and motor function (B)

23
Q

what is the criteria to determine the NLOI

A

intact sensation:
- (B) dermatomes (light touch and pinprick) normal at level (=2)

intact motor:
- key ms at that level has at least 3/5, rostral ms (innervated by nerve root above level) has to be 5/5

24
Q

what is the exception to the rule for motor levels and where does this apply

A

on areas with no myotomes, rely on dermatomes for classification
- if sensory 2, assume motor is 5

C1-4
T2-12
L1
S2-5

25
Q

what determines it to be a complete injury

A

absence of sensory and motor function in lowest sacral segment (S4/5)

26
Q

what are the criteria for incomplete injuries

A

partial preservation of sensory &/or motor function in lowest sacral segment (S4-5)

-or-

sparing of motor functioning 3 levels below motor level for that side of body

27
Q

how is partial preservation at the lowest sacral segment determined in incomplete injuries

A

S4/5 motor = voluntary anal contraction of external anal sphincter

S4/5 sensory = deep anal pressure or LT/PP at anal musculocutaneous junction

28
Q

what does an ASIA A classification mean

A

complete
- no sensory or motor function is preserved in the sacral segments S4-5

29
Q

what does an ASIA B classification mean

A

sensory incomplete
- S4/5 LT/PP or deep anal pressure

motor complete
- no preservation of fxn >3 levels below motor level
- no voluntary anal contraction

30
Q

what does an ASIA C classification mean

A

motor incomplete
- motor function preserved below NLOI
- more than half of key ms functions below NLOI have ms grade <3/5

31
Q

what does an ASIA D classification mean

A

motor incomplete
- motor function preserved below NLOI
- >/= 50% of key ms functions below NLOI have ms grade >3/5

32
Q

what is the functional prognosis differential b/w ASIA C vs D

A

C- some potential for amb, but less

D - has greater potential to amb, loner distances, w less AD

33
Q

what does an ASIA E classification mean

A

normal
- sensation and motor function graded normal in all segments
- pt had prior deficits

*someone w/o initial SCI doesn’t receive ASIA-AIS grade

34
Q

what is the patient’s lowest level of preservation if they have sacral sparing

A

S4/5

35
Q

who is appropriate for zone of partial preservation testing

A

complete SCIs
incomplete SCIs w missing motor (VAC) or sensory (LT, PP, DAP) in S4-5

36
Q

what does it mean for sensory ZPPs if DAP is present

A

sensory ZPPs on both sides aren’t defines and should be noted as n/a

37
Q

what does it mean for sensory ZPPs if DAP is absent

A

sensory ZPP can be defined on one side (assuming absent LT and PP in S4-5 on this side)
- may not be necessarily applicable (n/a) on other side if present LT or PP at S4-5

38
Q

what is a zone of partial preservation

A

lowest level w/ any sensory or motor

39
Q

what is a quick way to determine if a SCI is complete or not using a completed ASIA score sheet

A

complete SCI if bottom line reads “NOOON”

40
Q

totaling of motor and sensory scores are utilized for: (2)

A

monitoring change over time
prognostic for fxn recovery

41
Q

what are the 2 motor subscores

A

UE motor score (UEMS)
LE motor score (LEMS)

42
Q

what is the significance of a LEMS total

A

can prognosticate someone’s ability to amb

43
Q

what are the 2 sensory sub scores

A

light touch (LT)
pinprick (PP)

44
Q

ASIA A functional outcome

A

unlikely to recovery function below NLOI

45
Q

ASIA A functional outcome in cspine lesion vs tspine/lumbar

A

cspine - no chance of functional walking

tspine/lumbar - 8% chance to recover amb status (limited by AD and distance)

46
Q

ASIA B functional outcomes

A

1/3 of pts recovery amb
potential for conversion to C or D

47
Q

why has recent research been able to validate relationship b/w PP and recovery of amb

A

anatomic proximity of spinothalamic tracts to corticospinal tracts

48
Q

ASIA C functional outcomes

A

75% of amb recovery

49
Q

what is a major prognostic factor determining functional amb recovery in ASIA C

A

age:
pts <50yo have 80-90%
pts >50yo have 30-40%

50
Q

ASIA D functional outcomes

A

excellent potential for amb

51
Q

what is a major prognostic factor determining functional amb recovery in ASIA D

A

age:
pts </=50yo functional amb w/i 1yr post injury

older pts ~20% less likely to amb

52
Q

what are identified predictors of a pts chance of amb (I) 1yr post SCI

A

age
L3 and S1 motor scores & LT

53
Q

what are factors that inc likelihood of amb recovery

A

motor activation and LT at L3 and S1

54
Q

what are variable which better amb outcomes (4)

A

LEMS, motor scores
younger age
presence of PP
ZPP

Neuro Rehab 2 (48 decks)

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