SCI: ASIA Flashcards
What are the steps in determining the classification of individuals w/ SCI?
- Determine the sensory levels for R and L sides.
- Determine the motor levels for R and L sides. Note in regions where there is no myotome to test, the motor level is presumed to be the same as the sensory level.
- Determine the single neurological level. This is the lowest segment where motor and sensory function is normal on both sides and is the most cephalic of the sensory and motor levels determined in steps 1 and 2.
- Determine whether the injury is Complete or Incomplete.
COMPLETE: If voluntary anal contraction=NO, S4-5 All Sensory=0 and anal sensation=NO
Otherwise: INCOMPLETE
- Determine the ASIA grade:
Is the injury complete? Yes, ASIA A
No-> Is injury motor incomplete? NO, ASIA B Yes-> Are at least half of the key muscles below the single neurological level graded 3 or better? No-ASIA C Yes-ASIA D.
What are the grades in the ASIA Impairment Scale?
A=Complete: No motor or sensory function is preserved in the sacral segments S4-S5
B=Incomplete: Sensory but not motor function is preserved below the neurological level and includes the sacral segment S4-5.
C=Incomplete: Motor function is preserved below the neurological level, and more than half of key muscles below the neurological level has a muscle grade<3
D=Incomplete: Motor function is preserved below the neurological level and at least half of key muscle below the neurological level have a muscle grade of >3.
E=Normal: Sensory and motor function are normal.
Where are the dermatomes for the sensory assessment?
C2-3 cm behind the ear
C3-Supraclavicular fossa at the midclavicular line
C4- Over the acromion
C5-Lateral side of the anticubital fossa just proximal to the elbow.
C6- Dorsal surface of the proximal phalanx of the thumb.
C7- Dorsal surface of the proximal phalanx of the middle finger
C8-Dorsal surface of the proximal phalanx of the little finger.
T1-Medial side of the anticubital fossa, just proximal to the medial epicondyle of the humerus.
T2-Apex of the axilla
Always at the midclavicular line
T3- Find the 3rd rib and local the corresponding intercostal space below
T4- 4th intercostal space (level of nipples)
T5- 5th intercostal space
T6- Level of the Xiphoid process
T7- 1/4 of the way btwn the xiphoid and the umbilicus
T8- 1/2 of the way btwn the xiphoid and the umbilicus
T9- 3/4 of the way btwn the xiphoid and the umbilicus
T10- At the umbilicus
T11- 1/2 btwn umbilicus and inguinal ligament
T12- Midpoint of inguinal ligament
L1- Midway between T12 and L2
L2- Anterior medial thigh, at the midpoint from the inguinal ligament and the medial femoral condyle.
L3-Medial femoral condyle above the knee
L4-Medial Malleolus
L5-Dorsum of foot at 3 MTP joint
S1-Lateral aspect of the calcaneus
S2- Midpoint of popliteal fossa
S3/4/5- Not to be tested by PT.
What is the sensory grading system?
0-Absent
1-Impaired
2-Normal
What is the muscle grading system?
0=Total Paralysis
1= Palpable or visible contraction
2=Active movement full ROM, gravity eliminated
3=Active movement full ROM, against gravity
4=Active movement, full ROM, against gravity and provides some resistance
5=Active movement, full ROM. against gravity and provides normal resistance.
All tests done in supine
What movement do you test for C5?
Describe the procedure/position for each grade (0,1,2,3,4,5)
Elbow Flexors: Biceps and Brachioradialis
3: Pt starts w/ arm at side in a neutral position (elbow fully extended and F/A supinated). Examiner supports wrist and pt tries to actively go through full available ROM for elbow flexion.
4/5: Pt starts w/ elbow flexed to 90 degrees, examiner exerts a pulling force in direction of elbow extension. 1 hand at the shoulder and 1 hand at the wrist.
2: Pt starts w/ arm out at side and elbow in 30 degrees of flexion. Examiner supports arm at elbow and wrist. Pt tries to ben elbow going through full available ROM for flexion.
0/1: Same position as 2. Examiner supports forearm at the wrist and palpates the biceps tendon in the cubital fossa. Feel or observe a contraction as the pt attempts to move elbow through full ROM for flexion.
What movement do you test for C6
Wrist Extension: Extensor Carpi Radialis Longus and Brevis
3: Pt starts w/ arm at side in neutral (elbow fully extended, F/A pronated and wrist flexed). Examiner supports the distal forearm and pt tries to moe through full ROM for wrist extension.
4/5: Same position as 3, starting w/ wrist fully extended. Examiner stabilizes the wrist at the distal F/A and applies pressure across the metacarpals in a downward direction of flexion and ulnar deviation. Pt tries to maintain position.
0/1/2: Pt arm resting on table, position as above, F/A in neutral pronation/supination and wrist fully flexed. Examiner: support forearm at the wrist and palpates for radial wrist extensors proximal to the wrist on the radial side. Pt tries to move through wrist extension ROM.
What movement do you test for C7?
Elbow Extensors: Triceps
3: Pt starts w/ shoulder flexed to 90 degrees, elbow fully flexed and hand beside ear. Examiner supports upper arm near olecranon. Pt tries to extend elbow through full rom.
4/5: Same as 3, start in 45 degrees of elbow flexion. Examiner supports the upper arm and uses the other hand to apply resistance at the wrist into flexion.
2: Pt starts w/ elbow fully flexed. Examiner support pt’s upper arm as they try to extend elbow through full ROM.
0/1: Same as 2, elbow at 30 degrees of flexion. Support the F/A at the wrist and palpate the distal triceps at insertion on the olecranon as pt tries to extend through full ROM.
What movement do you test for C8?
Long Finger Flexors: Flexor Digitorum Profundus
3: Pt shoulder neutral, elbow fully extended F/A supinated. MCP and PIP of the middle finger stabilized in extension by the examiner using a two hand grasp. Pt attempts to flex DIP through full ROM.
4/5: Same as 3, start w/ DIP fully flexed. Examiner uses 1 hand to stabilize wrist, PIP and MCP and other hand applies resistance into extension at the distal phalanx middle finger.
0/1/2: Same as above, however F/A in neutral pronation-supination. Examiner uses 1 hand to stabilize the wrist, MCP and PIP. Other hand palpates for trace contractions of the long finger flexors as the pt tries to flex DIP through full ROM.
What movement do you test for T1?
Small Finger Abductor: Abductor Digiti Minimi
3: Pt Shoulder IR, Add, and 15 degrees flexion, elbow 90 flex and F/A pronated. Examiner supports pt’s hand and stabilizes MCP joints. Pt tries to move finger through full Abd ROM.
4/5: Same as 3, but pt starts in full abd. Use index finger to apply pressure against pt’s distal phalanx exerting force into adduction while pt resists.
0/1/2: Shoulder neutral, elbow extended and F/A pronated. Examiner stabilizes dorsal wrist and hand and palpates the abd digits minimi muscle for a contraction while pt attempts to abduct through full ROM.
What movement do you test for L2?
Hip Flexors: Iliopsoas
3: Pt starts w/ leg in neutral (15 degrees hip and knee flex). Examiner supports dorsal aspect of distal thigh and leg. Pt tries to flex hip to 90 degree w/ out dragging foot on table.
4/5: Pt starts w/ hip in 90 degrees flex, knee relaxed. Examiner stabilizes ASIS on opposite side and applies pressure in the direction of hip extension on the distal anterior thigh above the knee. Pt resists push.
2: Pt gravity eliminated position: knee flexed 90 degrees and hip ER/Flexion 45 degrees. Examiner supports leg while pt tries to move through full ROM hip flexion.
0/1: Pt in grade 3 position. Examiner palpates superficial hip flexors distal to ASIS and supports the thigh while pt tries to flex the hip. Examiner tries to palpate a contraction of superficial hip flexors.
What movement do you test for L3?
Knee Extensors: Quads
3: Examiner places arm under the tested knee and rests hand on pt’s opposite distal thigh to cause knee flex 30 degrees. Pt tries to extend knee through full ROM.
4/5: Same as 3 except knee in 15 degrees of flex to start. Examiner holds proximal to the ankle to push pt into knee flexion and pt tries to maintain position.
2: Pt start w/ 45 degrees hip ER/flex, knee flexed 90. Examiner supports distal thigh and leg. Pt tries to extend knee through ROM.
0/1: Leg neutral w/ 15 degree hip and knee flex. Examiner supports leg and palpates the patellar tendon or quadriceps muscles for trace contraction while pt tries to extend knee.
What movement do you test for L4?
Ankle Dorsiflexors: Tib Ant
3: Pt start in plantar flexion. Examiner supports the leg. Pt tries to DF ankle through full ROM.
4/5: Start in full DF. Examiner exerts downwards pressure on the dorsum of the foot into PF.
2: Leg out to the side position w/ ankle fully PF. Examiner supports leg and pt tries to DF through full ROM.
0/1: Pt start w/ leg in neutral. Examiner palpates tib ant muscle belly while pt tries to DF ankle.
What movement do you test for L5?
Long toe extensors: Extensor Hallucis Longus
3: Leg neutral position. Examiner can support the rest of the foot, pt tries to extend great toe through ROM.
4/5: Start w/ great toe in full extension. Examiner applies pressure downward into flexion at the distal phalanx of the great toe.
2: Leg out to the die position. Examiner supports the leg and pt attempts to extend great toe through ROM.
0/1: Leg neutral. Examiner supports leg w/ one hand and palpates the extensor tendon of the long toe while the pt attempts to extend through ROM.
What movement do you test for S1?
Ankle Plantar Flexors: Gastrocnemius
3: Hip in 45 degrees flexion, knee fully flexed and ankle full DF. Examiner has 1 hand behind knee and 1 hand under the sole of the foot pushing into DF. Pt pushes forefoot downwards into examiner’s hand and raises the heel of the table through full PF ROM.
4/5: Hip in neutral and knee extended and ankle PF. Examiner has one hand on the distal lower leg and other hand on plantar surface of the foot to apply pressure into DF.
0/1/2: Leg out to the side. Support lower leg. Examiner feels for trace contraction at the gastrocnemius as the pt attempts to PF ankle.
