Spinal Cord Injury - Part 3

Question 1

Evaluation Concept: Motor Level

Answer 1

Strength test (Grade 0-5). Most caudal key muscle group graded 3/5, with the muscles of the next cranial segment at 5/5.

Question 2

Evaluation Concept: Sensory Level

Answer 2

Most caudal dermatome to have normal sensation for pin and prick and light touch tests on both sides.

Question 3

Evaluation Concept: Zone of Partial Preservation

Answer 3

Segments below the neurological level that have preserved sensory or motor function in complete injuries (only ASIA A, Last levels having 0).

Question 4

Evaluation Concepts: Sacral Sparing

Answer 4

Voluntary contraction of external anal sphincter or anal sensation on rectal examination.

Question 5

Light Touch Test - Instructions, Analysis (3)

Answer 5

Do the test on the forehead first (not connected to the spinal cord, normal sensation), and ask patient to compare the other places to the sensation on the forehead.
0: Absent: patient does not feel light touch
1: Altered: patient feels light touch but not the same as forehead.
2: Normal: patient feels the same light touch as the forehead.

Question 6

Pin Prick Test

Answer 6

Ask patient if he feels the round surface or the prick, and ask if it’s similar to the sensation on the forehead.
0: Absent: Patient does not feel the prick OR does not differentiate prick and round surface.
1: Altered: Patient feels the difference between prick and round surface but it’s not the same as forehead.
2: Normal: Patient feels the difference and the feeling is similar to forehead.

Question 7

What is the sensory level in the assessment?

Answer 7

Last place where you had a 2. Compare PP and LT on right side and take the higher level, same on the left. Then compare right and left and take the higher level between the two.

Question 8

What is the motor level in the assessment?

Answer 8

Last level above or equal to 3 and has all upper levels 5.
Compare left and right side and take the higher level.

Question 9

What is the neurological level in the assessment?

Answer 9

Compare the sensory level to the motor level and take the higher level.

Question 10

Which assessment determines if the SCI is classified as complete or incomplete?

Answer 10

Sacral sparing.
Complete: No sacral sparing. NOON sign. The last row of the assessment is all no or 0.
Incomplete: Any sacral sparing.

Question 11

ASIA Impairment Scale Classification - AIS A

Answer 11

Motor and sensory Complete.
No on the last row.
No motor or sensory function preserved in sacral segments (S4/5)

Question 12

ASIA Impairment Scale Classification - AIS B

Answer 12

Sensory Incomplete.
Sensory but no motor below (has to be 3 or above) the NIL, includes sacral segments S4/S5

Question 13

ASIA Impairment Scale Classification - AIS C

Answer 13

Motor Incomplete.
Motor function preserved below NIL, and more than half of the muscles have grade <3 out of 5.

Question 14

ASIA Impairment Scale Classification - AIS D

Answer 14

Motor Incomplete.
Motor function preserved below NIL, and at least half of the muscles have grade 3 out of 5 or above.

Question 15

ASIA Impairment Scale Classification - AIS E

Answer 15

Motor and sensory function is normal. Not normal though, spinal cord lesion never normal.

Question 16

Complete Lesion - Signs

Answer 16

Patient goes through acute or shock phase, with signs of hypotonia, hyporeflexia, autonomic dysreflexia, muscle weakness, incontinence and paresthesia/anesthesia/hypoesthesia.