Recommended
More Related Content
More from Joe Antony
More from Joe Antony (20)
Recently uploaded
Recently uploaded (20)
International standards for neurological classification of spinal cord
- 1. INTERNATIONAL STANDARDS FOR NEUROLOGICAL CLASSIFICATION OF SPINAL CORD INJURY Dr Joe Antony JR 2,PMR
- 4. Steps ◦ Sensory testing on Cheeks ◦ If normal sensation cannot be established , Mark NT in all dermatomes ◦ Start with sensation from C2 to S2 ◦ Light Touch ◦ Pin Prick ◦ If any key sensory areas are not available, ◦ Due to burns,lacerations, casting etc ◦ Any other area in dermatome can be checked ◦ If alternate location used, should be mentioned in comment
- 5. Light touch ◦ Tool- Tapered wisp of cotton ◦ If alternative is used should be mentioned ◦ Method ◦ Start with establishing normal on cheeks ◦ Then test on dermatomes sequentioally ◦ Stroke with wisp of cotton over key sensory area over a 1cm area ◦ Compare with cheek ◦ Repeat for 10 times- 8 correct out of 10 is normal ◦ Grading ◦ 0- not able to differentiate ‘touched’ and ‘not toched’ ◦ 1- able to feel the touch, but is different from sensation on cheek (greater , lesser or otherwise different) ◦ 2- Normal ◦ NT- Key sensory area and rest of dermatome not available ◦ *- marked on abnormal score (0,1,NT) when score is impacted by Non SCI condition ◦ For classification purposes * will be considered as normal on levels above sensory level ◦ * at or below sensory level considered as abnormal.
- 6. Sharp/dull discrimination exam ◦ Tool-Clean, unused safety pin ◦ Method- same as soft touch ◦ Grading ◦ 0- No feeling or cannot reliably differentiate ◦ 1- Can reliably differentiate but less intense than on cheek ◦ 2- Can differentiate and of the same intensity as face. ◦ NT same as light touch
- 15. Challenging areas in Sensory examination ◦ T3 dermatome ◦ Sensation absent in T1 and T2 , but T3 has some sensation ◦ Supraclavicular nerves(C4) descent onto anterior superior chest ◦ Hence, If T2 and T4 dermatome are 0, T3 can also be scored 0 ◦ Patient not able to identify dull side of pin ( feeling sharp on dull) ◦ If “dull end” is less sharp than “sharp end” score as 1 ◦ If patient cant feel the difference, score as zero ◦ If patient feels dullness on sharp end, score zero
- 16. Common pitfalls ◦ Misinterpreting response ◦ “Yes” response for sharp pin testing is not enough to interpret as present. ◦ Age of the patient ◦ Children less than 5years doesn’t give consistent responses. ◦ Poor explanations ◦ Cognitive impairments ◦ Delayed sensory response ◦ May be due to abnormal pathways.
- 18. ◦ Key muscles ◦ To be tested in all patients ◦ Non key muscles ◦ To be tested in “Sensory incomplete “ 3 levels below motor level on each side to confirm motor incomplete status.
- 19. Differences from regular clinical testing ◦ Patient position- Always Supine in international standards examination ◦ Allows to comparison between acute to rehab phase ◦ does not allow true gravity-eliminated position in all muscle groups ◦ Patient’s body habitus and ROM also preclude a truly gravity-eliminated position ◦ Despite all this consistent positioning improves reliability ◦ No ‘+’ or “-” scoring ◦ NT designation option
- 20. Key muscles ◦ C5- Elbow flexors ◦ C6-Wrist extensors ◦ C7-Elbow extensors ◦ C8- Long finger flexors ◦ T1- Finger abductors ◦ L2- Hip flexors ◦ L3-Knee extensors ◦ L4- Ankle dorsiflexors ◦ L5-long toe extensors ◦ S1- Ankle PFs
- 21. How key muscles are selected
- 22. Non Key muscles ◦ When? ◦ To differentiate between Asia B and Asia C ◦ Test non key muscles 3 levels below NLI ◦ Ask patient if any movement is possible other than what is already done. ◦ No standardized testing. Even a powr of 1 in any group below 3 levels of NLI is enough to qualify ASIA C
- 23. Motor Grading NT grading and interpretation like sensory
- 24. Special Notes ◦ Contracture limits ROM ( More than 50% available)- Score like normal from 0-5 ◦ Contracture limits ROM (less than 50% available)- Score as NT ◦ Spasticity limit ROM- Score as NT if isolated movement not possible ◦ Abnormal response due to non SCI- Mark * with score and examiner judges how to use it in classification
- 25. Common pitfalls
- 26. Anorectal examination ◦ Verbally prepare the patient
- 27. Contraindication for anorectal examination ◦ Perineal Lacerations ◦ Burns ◦ Premorbid anorectal pathology
- 28. Steps ◦ First test external sensory examination ◦ Then internal exam
- 30. Grading
- 33. Steps
- 36. Thank you ◦ Refernce ◦ ASIA Instep training materials (ASIA e-Learning Center - American Spinal Injury Association (asia-spinalinjury.org)