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Asia scoring for spine trauma
The document provides information on assessing spinal cord injuries, including key muscles associated with different spinal cord levels, grading scales for muscle function and sensory ability, how to evaluate motor and sensory subscores, and the steps to classify a spinal cord injury as complete or incomplete. It defines a complete injury as having no sensory or motor function preserved in sacral segments S4-S5, while an incomplete injury has some sensory or motor function spared below the neurological level.
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Asia scoring for spine trauma
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- 3. KEY MUSCLES C5 –Elbow flexors C6- Wrist extensors C7 – Elbow extensors C8 – Finger Flexors T1 – Finger Abductors UPPER LIMB L2 – Hip Flexors L3 – Knee Extensors L4- Ankle Dorsiflexors L5 – Long toe extensors S1 – Ankle Plantar Flexors LOWER LIMB
- 4. Muscle Function Grading •0 = total paralysis • 1 = palpable or visible contraction • 2 = active movement, full ROM only with gravity eliminated • 3 = active movement, full ROM against gravity • 4 = active movement, full ROM against gravity & moderate resistance • 5 = (normal) active movement, full ROM against gravity and full resistance • 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)
- 5. Sensory Grading • 0= Absent • 1 = Altered, either decreased/impaired sensation • 2 = Normal • NT = Not testable
- 6. Motor subscores Upper Extremitymotor score total – out of 50 Upper Extremity Right – out of 25 Upper Extremity Left – out of 25
- 7. Lower Extremity motorscore total – out of 50 Lower Extremity Right – out of 25 Lower Extremity Left – out of 25
- 8. Sensory subscores Light touchtotal – out of 112 Light touch Right – out of 56 Light touch Left – out of 56
- 9. Sensory subscores Pin pricktotal – out of 112 Pin prick Right – out of 56 Pin prick Left – out of 56 Anal Tone - yes/no Deep anal pressure - yes/no
- 10. Steps in Classification •1. Determine sensory levels for right and left sides. • The sensory level is - most caudal, intact dermatome for both pin prick and light touch sensation. • 2. Determine motor levels for right and left sides. • Defined by the lowest key muscle function that has a grade of at least 3 (on supine testing), providing the key muscle functions represented by segments above that level are judged to be intact (graded as a 5).
- 11. • 3. Determinethe neurological level of injury (NLI) • This refers to the most caudal segment of the cord with intact sensation and antigravity (3 or more) muscle function strength • Provided that there is normal (intact) sensory and motor function rostrally respectively. • 4. Determine whether the injury is Complete or Incomplete. • (i.e. absence or presence of sacral sparing) • If • Voluntary anal contraction = No AND • All S4-5 sensory scores = 0 & • Deep anal pressure = No, then injury is Complete. Otherwise, injury is Incomplete.
- 12. Complete No sensory ormotor function preserved in sacral segments- S4 , S5 Sensory Incomplete Sensory segment below the neurological level including S4 & S5 preserved & no motor function is preserved > 3 levels below the motor level Motor Incomplete Motor Incomplete Normal Same as Sensory Incomplete & sparing of motor function >3 levels on I/L side on either side of the body Same as defined above with atleast half of the key muscle below the neurological level having 3 or more grade Sensation & motor function is normal in all segments
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