Understanding ASIA Scoring for Spinal Cord Injuries

Table of Contents

1. Introduction
2. Understanding Asia Scoring
3. Example: Patient with Spinal Cord Injury
   1. Explanation of Scoring Details
   2. Examination of Sensation on the Left Side
   3. Examination of Sensation on the Right Side
   4. Determining Neurological Level for Sensation
   5. Assessment of Motor Function
   6. Defaulting to Sensory Neurological Level for Motor Assessment
   7. Determining Neurological Level of Injury
   8. Identifying Complete or Incomplete Injury
   9. Determining Asia Grade for a Complete Injury
   10. Examining Zones of Partial Preservation

Introduction

Welcome back to Catalyst University! In this video, we will be discussing Asia scoring for patients with spinal cord injuries. Specifically, we will be focusing on a patient who presents with a spinal cord injury and analyzing their sensory and motor function. Understanding Asia scoring is crucial in determining the severity and extent of a spinal cord injury, so let's dive right in!

Understanding Asia Scoring

Before we proceed with the example, let's briefly discuss the basics of Asia scoring. The Asia impairment Scale is a standardized system used to evaluate and classify spinal cord injuries. It assesses both sensory and motor function in order to determine the severity of the injury.

The scoring system assigns a numerical value ranging from 0 (complete injury) to 5 (normal function) for each key sensory and motor component. The sensory components include light touch and pinprick sensation, while the motor components include muscle groups such as elbow extension, finger flexion, and finger abduction. These components are evaluated bilaterally on both sides of the body.

Based on the scores obtained, the Asia grading system categorizes spinal cord injuries into different levels, ranging from Grade A (complete injury) to Grade E (normal). Additionally, the zones of partial preservation, which indicate the lowest level of incomplete function, are also determined.

Now that we have a brief overview of Asia scoring, let's proceed with the example of a patient with a spinal cord injury.

Example: Patient with Spinal Cord Injury

In this example, we will be examining a patient who exhibits normal light touch and pinprick sensation on the left side and normal light touch sensation down to T6 on the right side.

Explanation of Scoring Details

Before diving into the specifics, it's important to note that the previous video discussed the detailed scoring process. If you are unfamiliar with the scoring details, please watch the previous video to gain a better understanding.

In this example, we will focus on a different facet of the scoring process - what happens when there is sensation down into the thoracic Spine, specifically T6.

Examination of Sensation on the Left Side

According to the question, the patient has normal light touch and pinprick sensation on the left side down to T6. This means that from C2 (at the top) down to T6, both light touch and pinprick sensation are normal.

Examination of Sensation on the Right Side

Similarly, the question states that the patient has normal light touch down to T6 on the right side. However, the pinprick sensation on the right side is normal only down to T7. This discrepancy between pinprick and light touch on the left side indicates a difference in sensation between the two sides.

Determining Neurological Level for Sensation

To determine the neurological level for sensation on both sides, we need to identify the lowest level where both light touch and pinprick sensations are intact. For the right side, this level is T6. Therefore, the neurological level for sensation on the right side is T6. On the left side, the neurological level for sensation is also T6.

Assessment of Motor Function

Moving on to motor assessment, we need to evaluate specific muscle groups, such as elbow extension, finger flexion, and finger abduction. These myotomes are clinically testable and help determine the motor function.

In this example, the patient exhibits a 5 out of 5 rating for elbow extension, finger flexion, and finger abduction on both sides. However, it's important to note that we don't have clinically testable myotomes between T2 and L1, causing a gap in the assessment.

Defaulting to Sensory Neurological Level for Motor Assessment

When there are no clinically testable myotomes in a particular region, we default to the sensory neurological level to determine the motor neurological level.

Since the sensory neurological level is T6 on both sides in this example, we will also consider T6 as the motor neurological level for both the right and left sides. This assumption is made because the motor function is likely to extend beyond T1, just like sensation does.

Determining Neurological Level of Injury

To determine the neurological level of injury, we examine the quadrant of four boxes that indicate the sensory and motor levels. In this case, all four boxes have the same level, T6. Therefore, the neurological level of injury is T6.

Identifying Complete or Incomplete Injury

Next, we assess whether the injury is complete or incomplete based on the criteria outlined in the question. For a complete spinal cord injury, three criteria must be met:

1. No ability to Elicit voluntary anal contraction
2. No deep anal pressure sensation
3. Absence of sensation in the S4-S5 area on both sides

In this example, the patient satisfies all three criteria, indicating a complete spinal cord injury.

Determining Asia Grade for a Complete Injury

For a complete spinal cord injury, the Asia grade is Grade A. This classification signifies the absence of both sensory and motor function below the neurological level of injury.

Examining Zones of Partial Preservation

Finally, we determine the zones of partial preservation for both sensory and motor function. The zones of partial preservation represent the lowest level of incomplete function in the sensory and motor systems.

On the right side, the sensory zone of partial preservation is T7, as it is the lowest level where there is any function. Similarly, the sensory zone of partial preservation on the left side is T6.

For motor function, we simply use the same level as the corresponding sensory zone of partial preservation. Hence, the motor zone of partial preservation is T7 on the right side and T6 on the left side.

These zones of partial preservation provide valuable information about the extent of preservation and can guide future rehabilitation efforts.

In the next video, we will delve into an example of an incomplete spinal cord injury and discuss how to handle such cases.

Thank you for watching! Be sure to like this video and subscribe to my Channel for future updates and notifications.

Highlights

• Asia scoring is a standardized system used to evaluate and classify spinal cord injuries.
• It assesses sensory and motor function to determine the severity of the injury.
• The scoring system assigns numerical values ranging from 0 to 5 for key components.
• Sensory and motor components are evaluated bilaterally on both sides of the body.
• The Asia grading system categorizes spinal cord injuries into different levels.
• Complete injuries are classified as Grade A, while incomplete injuries range from Grades B to E.
• Zones of partial preservation indicate the lowest level of incomplete function.
• Evaluating sensation and motor function is essential in determining the neurological level of injury.
• Important criteria for a complete spinal cord injury include the absence of voluntary anal contraction, lack of deep anal pressure sensation, and absence of sensation in the S4-S5 area on both sides.
• Determining the zones of partial preservation helps guide rehabilitation efforts.

FAQ

Q: What is the Asia scoring system? A: Asia scoring is a standardized system used to evaluate and classify spinal cord injuries. It assesses both sensory and motor function to determine the severity of the injury.

Q: How is Asia scoring performed? A: Asia scoring assigns numerical values ranging from 0 to 5 for sensory and motor components. These components are evaluated bilaterally on both sides of the body.

Q: What are the different levels of Asia grading? A: The Asia grading system categorizes spinal cord injuries into different levels, ranging from Grade A (complete injury) to Grade E (normal).

Q: What are zones of partial preservation? A: Zones of partial preservation indicate the lowest level of incomplete function. They provide valuable information about the extent of preservation and guide rehabilitation efforts.

Q: How do you determine the neurological level of injury in Asia scoring? A: The neurological level of injury is determined by examining the sensory and motor levels. The lowest level where both sensations are intact is considered the neurological level of injury.

Q: How do you differentiate between complete and incomplete spinal cord injuries in Asia scoring? A: In Asia scoring, a complete spinal cord injury is characterized by the absence of voluntary anal contraction, no deep anal pressure sensation, and no sensation in the S4-S5 area on both sides.

Resources:

• Asia Spinal Cord Injury Classification