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Unit 4 ASIA presentaiton Flashcards

(33 cards)

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1
Q

What is the ASIA

A

Standardized classification of spinal injury
For inter-rater reliability, testing is performed using a standard method in specified body locations

Like dermatome and myotome testing, however this is completed in supine.

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2
Q

Why perform the ASIA exam?

A

Classify levels of injury
Recovery prognosis

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3
Q

Sensory testing

A

28 key dermatomes are tested
Test light touch and pinprick
Face is used as the reference/control
Must examine in cephalo  caudal sequence

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4
Q

what is the score for sensory testing?

A

0 : absent
1: impaired
2: normal
NT: not tested

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5
Q

Light touch sensory testing protocol

A
  • Use cotton tip applicator
  • Touch skin ≤ 1 cm
  • Chest and abdominal points should be tested in the midclavicular line
  • Ask the patient to close their eyes and say “yes” when they feel the touch.
  • Repeat 5 times. Record the number of correct responses.
  • Ask the patient if it feels the same as the reference touch.
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6
Q

Pin prick sensory testing

A
  • Use a sterilized safety pin
  • Do not puncture skin
  • Chest and abdominal points should be tested in the midclavicular line
  • Use consistent pressure in each dermatome
    Alternate sharp and dull sides in irregular pattern
  • NOTE: if patient feels pin prick but can’t differentiate between sharp and dull, they are just sensing pressure and pin prick is scored 0.
  • Ask the patient to close their eyes and indicate whether they feel sharp or dull sensation.
  • Repeat 5 times, using random order of sharp and dull touches.
  • Ask the patient if it feels the same as the reference touch.
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7
Q

Perianal area sensory testing

A
  • S4/5 dermatome represents most caudal aspect of the spinal cord
  • Test S4/5 for both light touch and pin prick
  • Also test deep anal pressure
    On digital rectal exam, patient is asked to report sensory awareness
    Scored as ‘present’ or ‘absent’
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8
Q

Sensory Level

A
  • The level where sensory function - both pin prick and light touch- are intact on both sides of the body.
  • The lowest level where you have 2’s with all above being 2’s.
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9
Q

What sensroy level is this?

A

R: C8
L: C7
Overall: C7

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10
Q

Motor testing

A
  • 10 key muscle groups are included for scoring
  • Must examine in cephalo  caudal sequence
  • Tested in supine
  • Test each muscle on R and L before moving to next muscle
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11
Q

Scoring for motor testing

A

0: absent
1: muscle twitch
2: Full active ROM with gravity eliminated
3: Full active ROM against gravity
4: Able to generate some resistance
5: Normal strength

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12
Q

what are the key muscles motor testing

A

Upper extremities
* C5: elbow flexors
* C6: wrist extensors
* C7: elbow extensors
* C8: finger flexors
* T1: finger abductors

Lower extremities
* L2: hip flexors
* L3: knee extensors
* L4: ankle dorsiflexors
* L5: long toe extensors
* S1: ankle plantar flexors

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13
Q

Voluntary Anal contraction motor testing

A

Contraction of external anal sphincter around examiner’s finger
Scored ‘present’ or ‘absent’

The anorectal exam is critical to:
Develop management strategies for neurogenic bowel and bladder dysfunction
Most important indicator in predicting future recovery of function

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14
Q

Motor testing tips

A
  • Score ‘NT’ if you are unable to test due to pain, fracture, spasticity, uncontrolled clonus
  • Score ‘NT’ if there is a contracture that limits > 50% of ROM
  • NOTE: though key muscles are given a single level on ASIA for simplification (e.g. elbow flexors = C5), muscles are usually innervated by at least two roots (biceps = C5,6)
  • If you can’t test the motor (e.g. abdominals in thoracic region), then motor level is set as the same as the sensory level.
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15
Q

Motor Level

A

The level at which strength is at least 3/5 with all levels above being a 5/5.

Scored for each side and overall.

Overall score is the last intact side for both.

EXAMPLE
Left Motor Level: L3
Right Motor Level: L2
Overall Motor Level: L2

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16
Q

What is the motor level?

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A

R: C7
L: C6
overall: C6

17
Q

Neurological level of injury NLI

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A

The lowest level at which both motor and sensory modalities are intact on both sides of the body.
Sensory intact (2’s) bilaterally for both LT and PP and all above intact
Motor ≥ 3/5 bilaterally with all above being 5/5

18
Q

Complete vs Incomplete SCI

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A

Classification is based on ‘sacral sparing’

Sacral sparing: presence of any of the following
Light touch sensation at S4/S5
Pinprick at S4/5
Deep anal pressure
Voluntary anal contraction

Complete Injury: no sacral sparing
Incomplete Injury: any sacral sparing

19
Q

Zone of partial preservation

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A

Used only with complete injuries (AIS A)
Segments below neurological level of injury with preservation of sensory OR motor findings

Example:
If the NLI is C5, and some sensation extends on the right from C6-C8 then C8 is recorded in the right sensory ZPP box.

20
Q

AIS A

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A

No sensory or motor function preserved in the sacral segments (S4-S5)

21
Q

AIS B sensory imcomplete

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A

No motor function, but some sensation below the NLI including anal sphincter region

22
Q

AIS C motor incomplete

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A

Motor function preserved below the NLI but more than half of these muscles score <3/5

23
Q

AIS D motor incomplete

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A

Motor function preserved below NLI and at least half of the muscle groups scoring ≥3

24
Q

AIS E normal

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A

sensory and motor function are normal

25
AIS clssificaiton flowsheet
26
vibration test
* Tests the ability to detect vibratory sense. * Expose all the bony prominences that will be tested. * Demonstrate vibration in an area of intact sensation (reference). * Strike the tuning fork and place the stem away from a bony prominence (bone can conduct vibration to a proximal site). * Instruct the patient to say when they feel a vibration and when it stops. * Have the patient close their eyes. * Vary the amount of time in-between placing the stem on the patient’s bony prominence and stopping the vibration. * 5 probes at each location.
27
Vibration where to do it?
Upper extremity: Thumb DIP, styloid process of ulna, lateral/medial epicondyles olecranon process, and/or acromion process Lower extremity: Big toe DIP, lateral malleolus, medial malleolus, fibular head, greater trochanter and/or ASIS Scoring Normal: 5/5 probes correct and feels same as reference Impaired: 1-4 probes correct, or 5 probes correct but feels different from reference Absent: 0 probes correct Ideally, a 128 Hz tuning fork should be used, as this frequency provides a clearer separation of normal from abnormal vibratory sensation. ## Footnote DCML
28
Stereognosis
* Test the ability to perceive and recognize the form of an object in the absence of visual and auditory information, by using tactile information to provide cues from texture, size, spatial properties, and temperature. * Explain and demonstrate this procedure using common small items. * Ask the patient to close their eyes. Place object in the patient’s involved hand one at a time. * Ask the patient to identify each object. * Repeat this at least 5 times with different objects. Potential objects: safety pin, pen, coin, paper clip, toothbrush, comb, key, battery Use small and familiar objects ## Footnote DCML
29
Proprioception
* Tests static joint position sense * Demonstrate the test with the patient’s eyes open. * Support the limb with the least amount of hand contact needed. * Assess the full range of motion, find the midpoint of the range; tell the patient that this point will serve as the starting point/reference point. * “I am going to hold your segment above or below the starting position. This is above. This is below.” * Ask the patient to close eyes and identify whether the body part is placed above or below the starting position by responding verbally or with a hand signal. * Avoid end of ROM; repeat this at least 5 times. UE joints Thumb, wrist, elbow, shoulder LE joints Great toe, ankle, knee, hip ## Footnote DCML and spinocerebellar
30
Kinesthesia
* The ability to detect the movement of a joint in space.  * Demonstrate the test with the patient’s eyes open. * Support the limb with the least amount of hand contact needed.  * Assess the full range of motion. * “I am going to move your segment up or down. This is up. This is down.” * Ask the patient to close their eyes and identify whether the body part being moved up or down by responding verbally or with a hand signal.  * Avoid end of ROM.  * Repeat this at least 5 times. UE joints Thumb, wrist, elbow, shoulder LE joints Great toe, ankle, knee, hip ## Footnote DCML and Spinocerebellar
31
Two-point discrimination
* Ability to discern between 1 and 2 points of contact. * Explain and demonstrate at reference area * Have the patient close their eyes. * Alternate 1- and 2-point stimuli in random order. * Ask the patient to respond "one" or "two" based on the stimulus they feel. * Start with 2 points 4 millimeters apart and widen if patient is not able to distinguish points. * Repeat this at least 5 times. Normative Data Fingertips: 2-5mm Dorsum of fingers: 4-6mm Palm: 8-12mm Dorsum of hand, Extremities, Trunk: 20-30mm ## Footnote DCML
32
Graphesthesia
* The ability to recognize symbols (number or letter) when they're traced on the skin. * Explain and demonstrate the procedure to the patient with their eyes open on the reference area. * Instruct the patient to close their eyes. * Slowly draw a number or letter using your finger or a blunt instrument. Ask the patient to identify each stimulus. * Use letters or numbers that don’t involve lifting the stimulus from the patient’s hand to draw completely. * Repeat this at least 5 times.
33
Temperature
* To assess the ability to perceive the difference between hot and cold stimuli 1. Explain and demonstrate the procedure to the patient with their eyes open using reference area. 2. Ask the patient to close their eyes 3. Place the hot or cold probe against the patient’s skin. 4. Have the patient identify each stimulus as hot or cold 5. Vary the amount of time in-between the hot and cold stimuli

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