spinal cord injury 4

• impairment or loss of motor and/or sensory function in cervical segments of spinal cord
• doesn't include brachial plexus lesions or peripheral nerve lesions (can't be cord root)

• impairment or loss of motor and/or sensory function in the thoracid, lumbar, or sacral segments of the spinal cord
• doesn't include lumbosacral plexus lesions or peripheral nerve lesions
• (it's got to be a cord injury, not an injury anywhere else)

usage is discouraged due to imprecise descriptions of incomplete lesions... so don't say paresis, just plegia

• aka NLI
• the most caudal segment of the spinal cord with normal sensory and motor function on both sides of the body.
• but if segments differ L vs R, seperate levels should be stated

• most caudal segment of the spinal cord w normal sensory function on both sides of the body
• can have diff levels L vs R

• the most caudal segment of the spinal cord with normal motor function on bothsides of the boyd
• lowest key muscle that has a grade of at least 3, providing the key muscle of the segment above is tested to be 5

• radiographic level where greatest vertebral damage is found
• remember, level of bone is usually higher than the level of cord injury, except in cervical spine

partial preservation of sensory and/or motor function below the neruological level including the lowest sacra segment

• sensation at anal mucocutaneous junction
• deep anal sensation

voluntary contraction of the external anal sphincter upon digital stimulation

• absence of sensory & motor function in lowest sacral segment
• this is true regardless of the level of injury - if there's any motor or sensory down there, it's incomplete

• maintaining sensation in lowest sacral segments while there's absent or diminished motor function above
• this distinguishes complete from incomplete injuries

• this is used only with complete injuries (ie no sacral sparing)
• segments caudal to neurological level are partially inervated
• named for/defined by the most caudal segement w some (any) motor and/or sensory function

• predecessor to ASIA
• designed to quickly give a sense of how much function a pt has

• A: complete
• B: incomplete w preservation of some sensation below level of injury
• C: incomplete w preserved nonfunctional motor (useless) below level of injury, while sensation may or may not be preserved
• D: incomplete: preserved voluntary functional motor
• E: complete recovery - copmlete return of all motor & sensory function, but may still have abnormal reflexes

• A: complete
• B: incomplete w/ wensory but not motor below neurological level, down thru sacral segments S4-5
• C: incomplete w motor preserved below the neurological level and more than half the key muscles below the neuro level ahave a muscle grade <3 (0-2)
• D: incomplete w motor preserved below neuro level and at least half the key muscles below have muscle grade greater or equal to 3
• E: normal motor and sensory function

memorize general location of each zone

• C5 elbow flexors
• C6 wrist extensors
• C7 elbow extensors
• C8 finger flexors (DIP of middle finger)
• T1 finger abductors (use pinky)

• L2 hip flexors
• L3 knee extensors
• L4 ankle dorsiflexors
• L5 long toe extensors
• S1 ankle plantar flexors

C5-6 (and sometimes C4)

T6-12

• like Babinski test, but running it on the stomach -- if one side isn't enerverated the umbilicus will move toward the enervated side
• most striking at T9-12, but you can't tell the specific level in this test

L2-3

• 0-5 w/o +/-
• max score 25/extremity, total possible 100

• the lowest key muscle that has a grade of at least 3, providing the muscle above that level has a 5
• ex: C6 - 5, C5 - 3, C4 - 3 ... it's a C5 motor level
• C6 - 5, C5 - 4, C4 - 3 ... still C4

• if you have at least 50% of range, grade it thru that range
• if it has less than that range, mark it as NT (not testable)
• if spasticity or clonus prevents testing... NT

• lower extremity motor score (the MMT for the lower 5 key muscles)
• LEMS < 20 indicates limited ambulators
• LEMS > 30 suggests increased likelihood of being a community ambulator
• (this is an ASIA thing)

american spinal injury association

• 28
• 0, 1, or 2
• first do sharp/dull discrim (as compared to the face) w two ends of a safety pin
• then do light touch (cotton)
• total possible score 112 (28 x two sides x two types of stim)