Asia scale

spinal cord injury, ASIA scale

1. American Spinal Injury Association(ASIA) SCALE Dr Awaneesh Katiyar

2. Case Report A 30 yrs. Man presented in ED with history of fall from height (8 feet), vitals were normal, complaining of inability to move his lower limbs and severe backache Immediately after trauma. Motor lower limb – 0/5, upper limb - 5/5 Sensory level – at the level of inguinal region. No voluntary anal contraction, DAP, but sensation over S4-S5 present. ASIA grade?

3. History Frankel five-grade system  introduced - In 1969 , Frankel scale was adapted by ASIA- In 1982.

4. Frankel classification 1969 Frankel Grade Motor Sensory Grade A No motor function No sensory function. Grade B No motor function detected below level of lesion Some sensory function below level of lesion preserved Grade C Preserved motor, Nonfunctional Sensation may or may not be preserved Grade D Preserved motor, functional Normal Sensory Grade E Normal motor Normal Sensory

5. STEPS OF CLASSIFICATION Determine sensory levels for right and left sides. Determine motor levels for right and left sides . Determine the neurological level of injury (NLI ) Determine whether the injury is Complete or Incomplete Determine ASIA Impairment Scale (AIS) Grade

6. Determine sensory levels for right and left sides.

7. Determine motor levels for right and left sides. Lowest key muscle function that has a grade of at least 3 (on supine testing), Key muscle functions represented by segments above that level are judged to be intact . The motor level is presumed to be the same as the sensory level.

8. Key Muscles upper Extremity Upper extremities Elbow flexors C5 Wrist extensors C6 Elbow extensors C7 Finger flexors C8 Little finger abductor T1

9. Key Muscles lower extremities Lower extremities hip flexors L2 knee extensors L3 Ankle dorsiflesors L4 Long toe extensors L5 Ankle planter flexors S1

10. Determine the Neurological Level of Injury(NLI) The most caudal segment of the cord with intact sensation and antigravity (3 or more) muscle function strength, There is normal (intact) sensory and motor function rostrally respectively. The NLI is the most cephalad of the sensory and motor levels determined in steps 1 and 2.

11. Determine whether the injury is Complete or Incomplete If voluntary anal contraction = No AND all S4-5 sensory scores = 0 AND deep anal pressure = No, then injury is Complete . Otherwise , injury is Incomplete .

12. Determine ASIA Impairment Scale (AIS) Grade

13. ASIA IMPAIRMENT SCALE ASIA Grade Motor Sensory Grade A No motor function No sensory function included sacral sensation. Grade B Not motor function is preserved Sensory function intact or altered, decreased or hypersensitive Grade C Motor Incomplete - single NLI have a muscle grade ≥ 3. Sensory function intact or altered, decreased or hypersensitive Grade D Motor Incomplete - the single NLI having a muscle grade  3. Sensory function intact or altered, decreased or hypersensitive Grade E Normal. Normal

14. Muscle Function Grading 0 = Total paralysis 1 = Palpable or visible contraction 2 = Active movement, full range of motion (ROM) with gravity eliminated. 3 = Active movement, full ROM against gravity 4 = Active movement, full ROM against gravity and moderate resistance in a muscle specific position 5 = (Normal) active movement, full ROM against gravity and full resistance in a functional muscle position expected from an otherwise unimpaired person 5* = (Normal) active movement, full ROM 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 normal ROM)

15. Sensory Grading 0 = Absent 1 = Altered, either decreased/impaired sensation or hypersensitivity 2 = Normal NT = Not testable

16. Uses of ASIA chart Neurological assessment Daily evaluation and neurological assessment Diagnosis – spinal shock vs complete cord injury

17. Disability is not about nonfunctional limbs, but its about nonfunctional mind. Thank you ……… [email protected]