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Classification Of SCI Flashcards

(53 cards)

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1
Q

Classification of SCI

A
  • Developed by American spinal injury association (ASIA)
  • Involves standardized motor & sensory exam
  • Determines complete vs incomplete
  • Guides pt outcomes, prognosis and POC
  • Done after spinal shock resolves (72 hours)
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2
Q

Neurological level of injury

A
  • The level pt is diagnosed. The most rostral BILATERALLY out of the 4 levels (left motor, left sensory, right motor, right sensory)
  • pt has at least 3/5 muscle innervation AND intact sensation at this level 2
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3
Q

Motor assessment

A

10 key muscles
- Tested in supine in specific modified positions
- Graded 0-5 (0-4 grading is permitted if testing is limited due to other factors; fx, cast, pain)
- Good stabilization, proper positioning, observe for substitution
- Use clinical judgement: presence of pain, poor positioning, weakness secondary to disuse
- Max score = 50 for UE & LE (bilateral)

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4
Q

Grade 0 muscle testing

A

Total paralysis

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5
Q

Grade 1 muscle testing

A

Palpable or visible contraction (trace)

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6
Q

Grade 2 muscle testing

A

Active movement, full range of motion with gravity eliminated position

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7
Q

Grade 3 muscle testing

A

Active movement, full ROM against gravity

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8
Q

Grade 4 muscle testing

A

Active movement, full ROM against gravity and moderate resistance in a muscle specific position

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9
Q

Grade 5 muscle testing

A

Normal active movement, full ROM against gravity and full resistance in a functional muscle position expected form an otherwise unimpaired person

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10
Q

NT muscle grade

A

Not testable due to immobilization, severe pain such that the patient cannot be graded, amputation of limb, or contracture of >50% of the normal ROM

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11
Q

C5 muscle testing

A

Elbow flexors

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12
Q

C6 muscle testing

A

Wrist extensors

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13
Q

C7 muscle testing

A

Elbow extensors

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14
Q

C8 muscle testing

A

Finger flexors (DIP of middle finger)

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15
Q

T1 muscle testing

A

Finger abductor (little finger)

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16
Q

L2 muscle testing

A

Hip flexors

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17
Q

L3 muscle testing

A

Knee extensors

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18
Q

L4 muscle testing

A

Ankle dorsiflexors

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19
Q

L5 muscle testing

A

Long toe extensors (big toe)

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20
Q

S1 muscle testing

A

Ankle plantarflexion

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21
Q

Determination of motor level

A
  • Lowest myotome with intact innervation
  • Muscle grade of at least 3/5 AND rostral muscle function is 5/5
  • Can be different left and right
  • For myotomes not clinically testable, use sensory level***
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22
Q

Sensory examination

Study These Flashcards
A
  • 28 specific key points
  • Max score = 56 on each side of body
  • Light touch (DCML) and sharp/dull discrimination (ALS)
  • Most caudal level on that side of the body where both light touch and sharp/dull discrimination are intact = 2
23
Q

Grade 0 sensory testing

24
Q

Grade 1 sensory testing

25
Grade 2 sensory testing
Normal (same as the face)
26
Reference area for sensory assessment
The face b/c it is innervated by the trigeminal (5) cranial nerve
27
Light touch sensory exam
Using cotton ball - Say yes when you feel me touching you No response = absent (0) Yes = need follow up question - Does it feel the same as your face? Yes = intact (2) No = impaired (1)
28
Pain sensation testing
Using safety pin 3 trials, more if indicated - Tell me if this feels sharp or dull Unable to differentiate = absent (0) - Able to differentiate required follow up question - Does it feel the same as your face Yes = intact (2) No = impaired (1) would need to get 8/10 correct
29
Complete injury
No motor or sensory function is preserved in the sacral segments S4-S5 - No voluntary anal contraction - No deep anal pressure or light touch or pin prick
30
Incomplete injury
Sensory and/or motor function is present at the most distal segments S4-S5 - Deep analysis pressure may be absent but they may have some light touch or pin prick persevered at S4-S5
31
AIS A
- Complete - Motor VAC: absent - Sensory DAP: absent
32
AIS B
Incomplete - Motor VAC: absent - Sensory DAP: present (any sensory function at S4-S5 or DAP)
33
AIS C
- Motor incomplete - Motor VAC: present, <50% of key muscles have >/= 3/5 below NLI - Sensory DAP: present or absent with motor sparing >3 levels below the ipsilateral motor level on either side (non-key muscles too)
34
AIS D
- Motor incomplete - Motor VAC: present at least half of key muscles below NLI are >/= 3/5 - Sensory DAP: present or absent with motor sparing >3 levels below the ipsilateral motor level >/= 50% of muscles having >/= 3/5
35
AIS E
- Normal - Sensation and motor function graded as normal in all segments bilaterally - Someone without an initial SCI does not receive an AIS grade
36
Non-key muscles can count to for…
AIS C - Greater than 3 levels below the ipsilateral motor level with sensory sparing
37
Non-key muscles for C5
Shoulder: flexion, extension, abduction, adduction, internal and external rotation Elbow: supination
38
Non-key muscles for C6
Elbow: pronation Wrist: flexion
39
Non-key muscles for C7
Finger: flexion at PIP, extension Thumb: flexion, extension and abduction in plane of thumb
40
Non-key muscles for C8
Finger: flexion at MCP joint Thumb: opposition, adduction and abduction perpendicular to palm
41
Non-key muscles for T1
Finger: abduction of the index finger
42
Non-key muscles for L2
Hip: adduction
43
Non-key muscles for L3
Hip: external rotation
44
Non-key muscles for L4
Hip: extension, abduction, internal rotation Knee: flexion Ankle: inversion, eversion Toe: MP and IP extension
45
Non-key muscles for L5
Hallux and toe: DIP and PIP flexion & abduction
46
Non-key muscles for S1
Hallux: adduction
47
Not testable
Unable to determine the motor or sensory score at that level sure to injury, burn, fracture, wounds, peripheral nerve injuries, amputation, cast or immobilization, etc. - Reason for grade should be documented in comments box
48
Not determinable
If an area is not testable then a sensory or motor score for that side of the boy, neurological level of injury, zone of partial preservation, and/or AIS scale MAY not be determined
49
Using a * in ASIA scoring
- Used when motor or sensory function is impaired because of a non-SCI related condition Motor: 0*, 1*, 2*, 3*, 4*, NT* Sensory: 0*, 1*, NT* - Anytime we use clinical judgement to determine, we use a * which cannot be used to calculate the total score - If NT or NT* is present -> total score for sensory or motor on that side is not determinable though the level of injury may still be able to be determined
50
Zone of partial preservation
- Areas of intact motor and/or sensory function below the ipsilateral motor or sensory level in a patient who does NOT have sacral sparing on that side of the body - Can ONLY be present when a patient has ABSENT MOTOR OR SENSORY FUNCTION IN S4-S5; includes residual motor and/or sensory function below the ipsilateral motor or sensory level
51
Anytime voluntary anal contraction = no
You will document at motor ZPP bilaterally
52
Anytime deep anal pressure = no, and light touch and pin prick is 0 at S4-S5
You will document a sensory ZPP
53
Anytime voluntary anal contraction or deep anal pressure is preserved (including light touch and pin prick) meaning they have feeling or motor contraction…
There is NO ZPP, you will document N/A

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