ASIA

Question 1

ASIA is for patients older than __________

and should be performed __________ post injury

Answer 1

4 years old

72 hours

Question 2

Light touch tests what column?

How is the patient positioned?

What pattern do you follow?

Answer 2

DCML

Supine

Rostral to Caudal, test all of one side first followed by the other side

Question 3

What counts as a 1/2 for light touch

Answer 3

Patient reports being touched but it feels different than the control (face)

Question 4

What column does pin prick test?

how to test?

How many correct answers is considered normal

Answer 4

Spinothalamic

Randomly alternate between sharp and dull 10 times

8/10

Question 5

What is considered a 1/2 for sharp/dull testing

Answer 5

Patient can accurately distinguish between sharp/dull 8/10 times or more but reports it feels different than face

Question 6

__________ Defines an incomplete spinal cord injury

Answer 6

Any anal sensation or voluntary anal contraction

Question 7

________________ reliably predicted independent walking when performed 8-31 days after injury

Answer 7

Pin prick sensation at heel (S1)

L+R intact = 9/10 will independently walk

L or R = 8/10 will independently walk

Neither = 8/10 will not independently walk

Question 8

C4: 2 C4: 2

C5: 2 C5: 2

C6: 1 C6: 1

C7: 1 C7: 0

What is the sensory level?

Answer 8

C5

The sensory level is the most caudal segment of the spinal cord with 2/2 for pin prick and light touch

Question 9

What muscle groups correspond with C5, C6, and C7 on the ASIA scale

Answer 9

Elbow flexor

Wrist Extensor

Elbow Extensor

Question 10

What muscle groups correspond with C8 and T1

Answer 10

Finger flexors to the middle finger

Small finger abductor

Question 11

What muscle groups coorespond to L2, L3, and L4 on ASIA

Answer 11

Hip flexor

Knee Extensor

Ankle dorsiflexor

Question 12

What muscle groups correspond to L5 and S1 on asia

Answer 12

Long toe extensor

ankle plantarflexor

Question 13

How do you determine the motor level if the UE is intact, the LE is all 0s, and your sensory level is in the thoracic spine?

example: sensory level is T9

Answer 13

2/2 sensory = you assume motor is intact at that level aswell

so if the sensory level is T9 and there is no motor at L2-S1, you assume that the motor level is also T9

Question 14

What is the motor level:

C5: 5
C6: 5
C7: 4
C8: 2
T1: 0

Answer 14

Motor level is C7, the motor level is the first score above 3 that has a 5 above it

Question 15

Special rule for L2 and C5 motor level

Answer 15

Since there is no motor test for C4 and L1, you will assume these levels are 5/5 if they have intact sensory

So therefore if C4 Sensory is intact, and C5 motor score is a 3/5…

C5 is the motor level

Question 16

How do you determine the neurological level in ASIA

Answer 16

Most caudal segment (lowest) with both normal motor and sensory bilaterally

Question 17

Sensory Levels: R C4 L C3

Motor Levels: R C4 L C3

What is the neurological level?

Answer 17

C3

Question 18

What is the motor level?

Motor:
C5: 3
C6: 0
C7: 0
C8: 0
T1: 0

Sensory:
C2: 2
C3: 2
C4: 2
C5: 2

Answer 18

C5

you assume that C4 motor is intact since sensory is 2/2, and therefore anything 3/5+ with a 5/5 behind it is your motor level

Question 19

What is the skeletal level on asia?

Answer 19

The level that the greatest amount of damage is found on radiographic exam

Question 20

How do you classify a patient as complete or incomplete on asia?

Answer 20

If they have N voluntary anal contraction, 0,0 on S4-S5 on both sides, N deep anal pressure = Complete

Anything besides the NOOOON sign = incomplete

Question 21

What is sacral sparing?

Answer 21

preservation of either motor OR sensory function (or both) and must include the lowest sacral segments (S4/S5)

(Intact light touch/pin prick OR deep anal pressure or Voluntary anal sphincter contraction)

Question 22

Pt has sensory function at S4-S5 bilaterally, but no motor function

Answer 22

ASIA B = sensory incomplete

Question 23

Pt has no sensory or motor function at S4 S5 bilaterally

Answer 23

ASIA A = complete

Question 24

Pt w/ a Neurological level of C6,

Motor levels:
C6: 5
C7:2
C8: 2
T1: 1

L2: 0
L3:0
L4:0
L5:0
…
S4/S5: 2

VAC: yes
What is the ASIA classification

Answer 24

Motor incomplete (more than half of key muscles below neurological level are below 3/5)

Asia C

Question 25

Pt w/ a Neurological level of C6, Motor levels: C6: 5 C7:4 C8: 4 T1: 3 L2: 3 L3: 3 L4: 2 L5 : 1 … S4/S5: 2 What is the ASIA classification

Answer 25

ASIA D, Motor incomplete Half or more muscles below the neurological level are greater or equal to 3/5

Question 26

What is a pt's ASIA score if all components of an exam are normal

Answer 26

ASIA E, normal

Question 27

When is a ZPP, Zone of partial preservation used on ASIA?

Answer 27

Used only if no Sensory at S4/S5 and/or no motor at S4/S5 NOOOON refers to the single most preserved sensory and motor segments that remain partially innervated

Question 28

Can a pt with Voluntary anal contraction have a motor ZPP?

Answer 28

no

Question 29

Can a pt with a voluntary anal contraction have a sensory ZPP

Answer 29

yes, depending on pin prick/light touch at S4/S5 (must be absent)

Question 30

What is the sensory ZPP? T12: 2 L1: 2 L2 :1 L3: 1 L4: 0 L5: 0 S1:0 S2: 0 S3: 0 S4-S5: 2

Answer 30

no ZPP

Question 31

What is the sensory ZPP? T12: 2 L1: 2 L2 :1 L3: 1 L4: 0 L5: 0 S1:0 S2: 0 S3: 0 S4-S5: 0

Answer 31

L3

Question 32

What do we write on ASIA if something cannot be tested, example: They have an amputation

Answer 32

NT: not tested

Question 33

What do we add to an ASIA score if we believe that non-SCI conditions are contributing to that score example: peripheral nerve injures, burns, chronic pain, age-related weakness

Answer 33

an asterisk note: if you put an asteriks make sure you go back and explain in the comment box why

Question 34

What percent of ASIA A ambulate? ASIA B?

Answer 34

ASIA A: very little, 80% stay ASIA A, 20% convert to B or C and only 14% of those that convert will ambulate ASIA B: 33%

Question 35

What percent of ASIA C ambulate ASIA D?

Answer 35

ASIA C: 75% ASIA D: should recover and ambulate

Question 36

In ASIA B patients, what is considered a predictive factor for ambulation

Answer 36

spared pin prick sensation young age is a predictive factor

Question 37

T or F: ASIA testing is the same as manual muscle testing

Answer 37

F, it is an assessment of intact nerves, not strength

Question 38

What can be used as a substitute for deep anal pressure?

Answer 38

S3 pressure sensation

Question 39

Where is C2 sensory tested?

Answer 39

At least 1 cm lateral to occipital protuberance at base of skull, or 3 cm behind ear

Question 40

where is C3 and C4 tested?

Answer 40

C3 in supraclavicular fossa C4 over AC joint

Question 41

Where is C5 and C6 tested

Answer 41

C5: lateral side of antecubital fossa (Just proximal to elbow) C6: Dorsal surface of the proximal phalanx of thumb

Question 42

Where is C7 and C8 tested?

Answer 42

C7 Dorsal surface of proximal phalanx of middle finger C8 Dorsal surface of proximal phalanx of little finger

Question 43

Where is T1 and T2 tested?

Answer 43

T1: Medial side of antecubital fossa (just proximal to lateral epicondyle) T2: Apex of axilla (armpit)

Question 44

Where is T4 tested?' T10? T12?

Answer 44

Located at level of nipples Located at level of umbilicus Midpoint of inguinal ligament

Question 45

Where is L1, L2, and L3 tested?

Answer 45

L1: MIdway between T12 and L2 L2: Anterior-medial thigh L3 Medial femoral condyle above knee

Question 46

Where is L4 and L5 tested?

Answer 46

L4: Medial malleolus L5: Dorsum of foot at third MTP joint

Question 47

Where is S1 and S2 tested?

Answer 47

S1: Lateral aspect of calcaneus S2: Midpoint of popliteal fossa

Question 48

Where is S3 and S4/5 tested?

Answer 48

S3: Ischial tuberosity S4/5: Perianal area, less than 1 cm lateral to mucocutaneous junction

Question 49

T or F: When preforming ASIA we should test both C5 myotomes, then both C6, then both C7..

Answer 49

F, should do all of one side then switch

Question 50

ASIA C5 myotome

Answer 50

Elbow flexors

Question 51

ASIA C6 myotome

Answer 51

Wrist extensors

Question 52

ASIA C7 myotome

Answer 52

Elbow ext

Question 53

ASIA C8 myotome

Answer 53

Finger flexors to MIDDLE FINGER at the DIP

Question 54

Asia T1 myotome

Answer 54

Small finger abductor

Question 55

ASIA L2 myotome

Answer 55

Hip flexors

Question 56

ASIA L3 myotome

Answer 56

Knee extensors

Question 57

ASIA L4 myotome

Answer 57

Ankle dorsiflexors

Question 58

ASIA L5 myotome

Answer 58

Long toe extensors

Question 59

ASIA S1 myotome

Answer 59

Ankle plantarflexors

Question 60

Pt w/ last tested motor level at T1 at 5/5, pt sensory level at T11, what is the motor level?

Answer 60

T11

Question 61

What 2 ways is motor level tested for C1-C4 on ASIA? For T2-L1? S2-S5?

Answer 61

C1-C4 sensory level and diaphragm T2-L1 Sensory level and beevors sign (abdominal contraction) S2-S5 sensory level and anal sphincter

Question 62

What position does every muscle test take place in for ASIA?

Answer 62

SUPINE

Question 63

If a pt cannot preform a 3/5 on an ASIA muscle test, what do we do next?

Answer 63

Test in scarecrow position for UE and ballerina position for LE for 2/5 or less

Question 64

what do we assess before performing an ASIA muscle test?

Answer 64

assess ROM also note: ALWAYS PALPATE MUSCLE YOU'RE TESTING

Question 65

What is the common muscle substitution for C6 wrist extensors

Answer 65

Forearm supination and the use of gravity

Question 66

what is the common muscle substitution for C7 elbow extensors

Answer 66

Externally rotating the shoulder, then quickly flexing the elbow and activating spasticity in triceps palpation of triceps should be done during test

Question 67

what is the common muscle substitution for C8 long finger flexors

Answer 67

Grade 1-3 involuntary movement of phalanx d/t wrist ext Grade 4-5 use of hand intrinsic and flexor digitorum superficialis

Question 68

When testing C8 motor level, where do we add resistance?

Answer 68

stabilize the MCP and PIP in extension, try to add resistance to the DIP!

Question 69

what is the common muscle substitution for T1 small finger abductor

Answer 69

finger extension can mimic 5th finger abduction

Question 70

What is the common substitution for L2 hip flexors?

Answer 70

Abdominal muscles elevating or rotating pelvis

Question 71

What is the common substitution for ankle dorsiflexors?

Answer 71

Extensor hallicus longus

Question 72

What is the common substitution for long toe extensors L5

Answer 72

Active plantarflexion or active flexion followed by relaxation may mimic extension

Question 73

What is the common substitution for S1 ankle plantarflexors?

Answer 73

Pt may flex hip to bring heel off of mat

Question 74

L2: 5 L3: 5 L4: 1 L5: 1 What is the motor level?

Answer 74

L3

Question 75

How can a patient have motor incomplete status if they don’t have VAC?

Answer 75

If they have 3 levels of preserved motor function below their motor level on either side Example: Motor level: C7 Motor scores: C5: 5 C6: 5 C7: 3 C8: 2 T1: 2 L2: 1 VAC: N

Question 76

Pt has a motor level of C5, but has working elbow Pronators, finger extensors, and thumb abduction Pt with no VAC

Answer 76

Motor incomplete, Has 3 non-key muscle groups functioning below c5

Question 77

Pt is a motor level of L2, but has hip adductors, hip extension, and hip external rotation No VAC

Answer 77

Motor incomplete Pt with 3 or more non-key muscle groups functioning below their motor level

Question 78

Pt with a motor level of C6 , but also has working wrist flexors (C7) No VAC

Answer 78

Sensory incomplete Pt does not have 3 motor levels functioning below their official motor level

Question 79

What specific muscle is tested for C5?

Answer 79

Biceps brachii, Brachialis

Question 80

What specific muscle is tested for C6?

Answer 80

ECRL/ECRB

Question 81

What specific muscle is tested for C7?

Answer 81

Triceps

Question 82

What specific muscle is tested for C8?

Answer 82

Flexor Digitorum Profundus

Question 83

What specific muscle is tested for T1?

Answer 83

Abductor Digiti Minimi

Question 84

What specific muscle is tested for L2?

Answer 84

Iliopsoas

Question 85

What specific muscle is tested for L3?

Answer 85

Quadriceps

Question 86

What specific muscle is tested for L4?

Answer 86

Tibialis Anterior

Question 87

What specific muscle is tested for L5?

Answer 87

Extensor Hallucis Longus

Question 88

What specific muscle is tested for S1?

Answer 88

Gastrocnemius and Soleus

Question 89

What factors are included in the prognostic walking CPR?

Answer 89

Age 65 or more? (Negative) Motor score of L3 Motor score of S1 Light touch at L3 Light touch at S1