The ASIA Exam

Question 1

How do we find the motor level in the ASIA exam?

Answer 1

the most caudal segment with normal motor function on each side of body - evaluated by assessing myotomes and voluntary anal contraction

Question 2

How do we find the sensory level in the ASIA exam?

Answer 2

the most caudal segment with normal sensory function on each side of body - evaluated with key sensory point within 28 dermatomes and deep anal sensation.

Question 3

Explain scoring of dermatomes

Answer 3

2 - normal sensation
1 - altered sensation
0 - absent sensation

Question 4

How does muscle function testing differ from standard MMT for ASIA exam?

Answer 4

• Entire exam in supine
• No + or - scores
• Option for documented Not testable (NT)

Question 5

What are the UE Key Muscles?

Answer 5

C5: elbow flexors
C6: wrist extensors
C7: elbow extensors
C8: finger flexors
T1: finger abduction (little finger)

Question 6

What are the LE Key Muscles?

Answer 6

L2: hip flexors
L3: knee extensors
L4: ankle DF
L5: long toe extensors
S1: ankle PF

Question 7

Why were the key muscles chosen?

Answer 7

1. Representative of each spinal cord segment
2. Each muscle/action has functional significance
3. Each muscle/action is adequately accessible and easily isolated in supine
4. Each muscle has innervation of at least 2 spinal segments.

Question 8

If a sensory level (LT/PP) =2, what can be assumed about motor function?

Answer 8

presumed that motor would be 5

Question 9

Why are there non-key muscles included in the ASIA exam?

Answer 9

• Determine AIS-B vs AIS-C
• Helpful to prep for functional capabilities

Question 10

What is the neurological level of injury and how do we find it? What does it represent?

Answer 10

• most caudal segment of SC with normal sensory and antigravity muscle function on both sides of body.
• Prognostic indicator and expected functional capabilities.

Question 11

What are the components of the rectal exam for the ASIA and why are they relevant?

Answer 11

Digital stem + flex finger, able to feel? Y or N, ask pt to tighten and relax anal muscles on command.

False positive: tone, bearing down

Question 12

How does the ASIA differentiate between complete versus incomplete injuries?

Answer 12

• Complete: absence of sensory and motor at S4-5
• Incomplete: partial preservation of sensory + motor funciton at S4-5

Question 13

What are zones of partial preservation? When do we report them?

Answer 13

Dermatomes and myotomes caudal to sensory and motor levels with paritally preserved functions (recorded as single lowest preserved segment on right and left exam)

Question 14

If no key muscles have partial motor function caudal to the NLI, the motor ZPP would be…

Answer 14

the same as the original motor level

Question 15

ASI-A

Answer 15

NO sensory or motor function is preserved in the sacral segments S4-5.
*ZPP may be present. *

Question 16

ASI-B

Answer 16

Sensory preserved below NLI, including the sensory sacral segments S4-5.
AND
NO motor function >3 levels below the motor level on either side of the body (key + non-key muscles)

Question 17

ASI-C

Answer 17

Motor function preserved at the most caudal sacral segments for VAC.
OR
AIS-B status AND some sparing of motor function >3 levels below IPSI motor level on either side of body (key muscles)

<50% of key muscles function below the single NLI have muscle grade greater than or equal to 3.

Question 18

ASI-D

Answer 18

Motor incomplete status AIS-C BUT with at least half or more key muscle functions below the sinle NLI with muscle grade of 3 or more.

Question 19

If an individual survives the first 24 hours post-SCI, statistically they will likely be alive how many years later?

Answer 19

10

Question 20

Why is acute mortality higher in the first year post-injury?

Answer 20

Medical complications, emotional, lifestyle changes, autonomic dysfunction, etc.

Question 21

What are the leading secondary sequela that lead to death?

Answer 21

Pneumonia <– COUGH control
Septicemia <– lack of sensation

Question 22

What is the number one prognostic indicator to tell if a patient will be able to ambulate after SCI?

Answer 22

ASIA level on Initial Eval

Question 23

What other indicators affect prognosis to ambulate?

Answer 23

• Early exam of reflexes
• SCI syndromes
• Acquired SCI less likely than traumatic SCI
• Age

Question 24

In general, what do we know about the potential to improve ASIA levels in one year?

Answer 24

Most people will be the same ASIA level one year later, except a level C might improve to a level D