asia grade terminilogy.pptx spinal shock

frankels grading

1. American Spinal Injury Association (ASIA) Impairment Scale International Standards for Neurological Classification of Spinal Cord Injury ( ISNCSCI )

2. Introduction The ISNCSCI provides a standardized examination method to determine the extent of motor and sensory function loss after SCI. It is a universal classification tool for spinal cord injuries based on a standardized sensory and motor assessment. The examination determines: Sensory Level and Motor Level for each side of the body (Right and Left) Neurological Level of Injury (NLI) whether the injury is Complete or Incomplete .

3. Dermatomes and Myotomes C ombination of two Greek words; “derma” meaning “skin”, and “tome”, meaning “cutting” or “thin segment”. A reas of the skin whose sensory distribution is innervated by the afferent nerve fibres from the dorsal root of a specific single  spinal nerve   root, which is that portion of a peripheral nerve that “connects” the nerve to the spinal cord. A myotome ( greek : myo =muscle, tome = a section, volume) is defined as a group of muscles which is innervated by single spinal nerve root.

4. AIM of ASIA scale S tandardised and detailed documentation of the SCI neurological level of injury G uidance for radiographic assessment and treatment to determine if the SCI is complete or incomplete . [

5. Sensory examination Testing is done bilaterally using Light Touch (LT) and Pin-Prick (PP) [sharp-dull discrimination]. Items used: a cotton tip  safety pin We follow the dermatomal pattern for sensory assessment. The sensory key points are used for standardized assessment technique. C omparison of the LT is done with the sensation on the patient’s cheek.

6. Three-Point Scale for Sensory Scoring = Absent 1 = Altered - Impaired or Partial Appreciation, including Hyperesthesia 2 = Normal or Intact - Similar as on the cheek NT = Not Testable

7. Motor examination Assessment follows the mytomal distribution. Key muscles are assessed for each myotome. I nvolves the grading of five specific muscle groups in the upper and lower extremities.

8. Motor grades Total Paralysis 1 Palpable or Visible Contraction 2 Active Movement, Full Range of Motion with Gravity Eliminated 3 Active Movement, Full Range of Motion Against Gravity 4 Active Movement, Full Range of Movement against Gravity and Moderate Resistance in a Muscle Specific Position 5 Normal Active Movement, Full Range of Motion Against Gravity and Full Resistance in a Muscle Specific Position expected from an Unimpaired Person 5* Normal Active Movement, Full Range of Motion Against Gravity and Sufficient Resistance to be considered normal if identified Inhibiting Factors i.e., pain, disuse were not present NT Not Testable i.e., due to Immobilization, Severe pain such that the patient cannot be graded, Amputation of Limb, or Contracture of >50% of the Range of Motion

9. Deep anal pressure - awareness is examined by insertion of the examiner’s index finger and applying gentle pressure to the anorectal wall. Voluntary Anal Contraction- is examined by asking the patient to “ squeeze the examiner’s finger as if to hold back a bowel movement.” A contraction is graded as Absent (0) or Present (1) Instruct the patient to not hold breath.

10. Interpretations: Sensory Level refers to the most caudal , intact dermatome for both light touch and pin-prick sensation (Score = 2). Motor Level refers to the most caudal myotome with a key muscle function of Grade 3 on Motor Examination. Neurological Level of Injury refers to the most caudal segment of the cord with both intact sensation and antigravity muscle function strength (Grade 3 or more) on both sides of the body , provided that there is normal/intact sensory and motor function (Grade 5) rostrally. If there is a discrepancy between the most caudal intact section between the four possible levels of Right-Sensory Level, Left-Sensory Level, Right-Motor Level, or Left-Motor Level, the Neurological Level of Injury is considered the most cephalad segment of these four levels.

11. ASIA Impairment Scale (AIS) Spinal cord injuries are classified in general terms of being neurologically “complete” or “incomplete” based upon sacral sparing.  Sacral sparing  "refers to the presence of sensory or motor function in the most caudal sacral segments as determined by the examination (i.e. preservation of light touch or pin prick sensation at the S4-5 dermatome, DAP [deep anal pressure] or voluntary anal sphincter contraction)

12. Complete Injury:  absence of sacral sparing i.e. no sensory and motor function at S4-5 Incomplete Injury:  presence of sacral sparing i.e. partial preservation of sensory and/or motor function at S4-5 Sensory Incomplete:  sacral sparing of sensory function Motor Incomplete:  sacral sparing of motor function or sacral sparing of sensory and motor function more than 3-levels below the level of injury

13. Zone of Partial Preservation refers to the dermatomes and myotomes caudal to the sensory or motor level that remain partially innervated.  determined by the most caudal segment with some sensory or motor function respectively, and should be recorded for both right and left sides and for sensory and motor function.

14. Motor ZPP is recorded in incomplete injuries with absent VAC. Sensory ZPP is recorded in the absence of sensory function in S4-5 (light touch and pin-prick), as long as DAP is not present. In the presence of DAP, Sensory ZPP should be noted as “not applicable (NA)”. In the absence of DAP, sensory ZPP can be recorded if there is absence of light touch and pin-prick sensation at S4-5, while it should be noted as “not applicable (NA)” if there is presence of light touch or pin-prick sensation at S4-5

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