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tetraplegia def by ASIA
- 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)
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paraplegia def by ASIA
- 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)
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quadriparesis & paraparesis - thoughts on these words?
usage is discouraged due to imprecise descriptions of incomplete lesions... so don't say paresis, just plegia
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neurological level of injury (per ASIA)
- 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
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SLI: sensory level of injury (per ASIA)
- most caudal segment of the spinal cord w normal sensory function on both sides of the body
- can have diff levels L vs R
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MLI: motor level of injury (per ASIA)
- 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
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SkLI: skeletal level of injury
- 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
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incomplete injury
partial preservation of sensory and/or motor function below the neruological level including the lowest sacra segment
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sacral sensation includes...?
- sensation at anal mucocutaneous junction
- deep anal sensation
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motor function at lowest sacral segment includes...?
voluntary contraction of the external anal sphincter upon digital stimulation
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complete injury
- 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
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sacral sparing
- maintaining sensation in lowest sacral segments while there's absent or diminished motor function above
- this distinguishes complete from incomplete injuries
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ZPP: zone of partial preservation
- 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
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Frankel Scale
- predecessor to ASIA
- designed to quickly give a sense of how much function a pt has
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grades in the Frankel Scale
- 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
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Letter grades on ASIA impairment scale
- 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
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see pg 88 of the body dermatome map
memorize general location of each zone
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5 key UE muscles
- C5 elbow flexors
- C6 wrist extensors
- C7 elbow extensors
- C8 finger flexors (DIP of middle finger)
- T1 finger abductors (use pinky)
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5 key LE muscles (descriptions, not names)
- L2 hip flexors
- L3 knee extensors
- L4 ankle dorsiflexors
- L5 long toe extensors
- S1 ankle plantar flexors
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deltoid is what nerve roots?
C5-6 (and sometimes C4)
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abs are what n roots?
T6-12
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Beevor's sign -- what is it? most striking where?
- 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
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hip adductors are what N root?
L2-3
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scoring in ASIA's mmt
- 0-5 w/o +/-
- max score 25/extremity, total possible 100
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motor level per ASIA
- 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
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how to grade a muscle if ROM is decreased
- 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
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LEMS and implications
- 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)
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asia stands for what
american spinal injury association
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sensory points (ASIA) how many are there? graded how? how to stim them?
- 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)
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