SCI - 2 ASIA Flashcards
international standards of neurologic classification of SCI (ISNCSCI) vs ASIA
ISNCSCI: measures extent of neurologic injury following a SCI
ASIA: categorizes degrees of injury into different groups
what are the 6 steps for classification of SCI
- sensory R/L
- motor R/L
- neurological level of injury (NLI)
- complete or incomplete
- ASIA
- zone of partial preservation
how do you determine if someone is complete vs incomplete
if there is any sacral sparing in sensory/motor function of S4-5
what is the most important predictor of recovery
zone of partial preservation
what are the corresponding SC tracts tested during the sensory exam of the ASIA
pinprick = lateral spinothalamic
light touch = anterior spinothalamic, dorsal column
how is the most caudal sensory level determined in the ASIA
most caudal, normally innervated dermatome for both pinprick (sharp/dull discrimination) and light touch
- score = 2
how were the key ms groups chosen in the ASIA
nerve group that innervates the ms group w the most significant impact on function
what are the the 5 UE key ms groups for the ASIA motor exam
C5 = elbow flexors
C6 = wrist ext
C7 = elbow ext
C8 = finger flex
T1 = 5th finger ABD
what function do C5 key ms support
eating
what function do C6 key ms support
tenodesis grip
- use of wrist ext to automatically flex fingers
what function do T1 key ms support
open fingers to hold objects
what are the 5 LE key ms groups for the ASIA motor exam
L2 = hip flexors
L3 = knee ext
L4 = ankle DF
L5 = long toe (2nd digit) ext
S1 = ankle PF
what function do the LE key ms groups support
mobility and ambulation
what are 6 considerations for the ASIA motor exam
- check available ROM
- stabilize prox
- consistent use of supine
- LE gravity eliminated position (45deg hip flex and full ER)
- ms substitutions
- spasticity and/or contractures
what is a grade of 5* on the motor exam of the ASIA
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
what ms substitution should you watch for when testing for the triceps in a motor exam
shoulder ERs
what ms substitution should you watch for when testing for the finger flexors in a motor exam
a tenodesis grasp
what ms substitution should you watch for when testing for the finger ABDs in a motor exam
finger ext
what ms substitution should you watch for when testing for the ankle DFs in a motor exam
long toe extensors
what ms substitution should you watch for when testing for the great toe ext in a motor exam
PFs
what is the ASIA’s ms grading (which is different from MMT)
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
what is a neurological level of injury (NLOI)
most caudal level of SC that exhibits intact sensory and motor function (B)
what is the criteria to determine the NLOI
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
what is the exception to the rule for motor levels and where does this apply
on areas with no myotomes, rely on dermatomes for classification
- if sensory 2, assume motor is 5
C1-4
T2-12
L1
S2-5
what determines it to be a complete injury
absence of sensory and motor function in lowest sacral segment (S4/5)
what are the criteria for incomplete injuries
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
how is partial preservation at the lowest sacral segment determined in incomplete injuries
S4/5 motor = voluntary anal contraction of external anal sphincter
S4/5 sensory = deep anal pressure or LT/PP at anal musculocutaneous junction
what does an ASIA A classification mean
complete
- no sensory or motor function is preserved in the sacral segments S4-5
what does an ASIA B classification mean
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
what does an ASIA C classification mean
motor incomplete
- motor function preserved below NLOI
- more than half of key ms functions below NLOI have ms grade <3/5
what does an ASIA D classification mean
motor incomplete
- motor function preserved below NLOI
- >/= 50% of key ms functions below NLOI have ms grade >3/5
what is the functional prognosis differential b/w ASIA C vs D
C- some potential for amb, but less
D - has greater potential to amb, loner distances, w less AD
what does an ASIA E classification mean
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
what is the patient’s lowest level of preservation if they have sacral sparing
S4/5
who is appropriate for zone of partial preservation testing
complete SCIs
incomplete SCIs w missing motor (VAC) or sensory (LT, PP, DAP) in S4-5
what does it mean for sensory ZPPs if DAP is present
sensory ZPPs on both sides aren’t defines and should be noted as n/a
what does it mean for sensory ZPPs if DAP is absent
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
what is a zone of partial preservation
lowest level w/ any sensory or motor
what is a quick way to determine if a SCI is complete or not using a completed ASIA score sheet
complete SCI if bottom line reads “NOOON”
totaling of motor and sensory scores are utilized for: (2)
monitoring change over time
prognostic for fxn recovery
what are the 2 motor subscores
UE motor score (UEMS)
LE motor score (LEMS)
what is the significance of a LEMS total
can prognosticate someone’s ability to amb
what are the 2 sensory sub scores
light touch (LT)
pinprick (PP)
ASIA A functional outcome
unlikely to recovery function below NLOI
ASIA A functional outcome in cspine lesion vs tspine/lumbar
cspine - no chance of functional walking
tspine/lumbar - 8% chance to recover amb status (limited by AD and distance)
ASIA B functional outcomes
1/3 of pts recovery amb
potential for conversion to C or D
why has recent research been able to validate relationship b/w PP and recovery of amb
anatomic proximity of spinothalamic tracts to corticospinal tracts
ASIA C functional outcomes
75% of amb recovery
what is a major prognostic factor determining functional amb recovery in ASIA C
age:
pts <50yo have 80-90%
pts >50yo have 30-40%
ASIA D functional outcomes
excellent potential for amb
what is a major prognostic factor determining functional amb recovery in ASIA D
age:
pts </=50yo functional amb w/i 1yr post injury
older pts ~20% less likely to amb
what are identified predictors of a pts chance of amb (I) 1yr post SCI
age
L3 and S1 motor scores & LT
what are factors that inc likelihood of amb recovery
motor activation and LT at L3 and S1
what are variable which better amb outcomes (4)
LEMS, motor scores
younger age
presence of PP
ZPP
