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    Question about ASIA classification

    Dear all,

    Just thought you might be able to help me understand the ASIA classifications. I saw you put the list up in Ian's thread, and I remembered a question I had about it.

    I understand that for ASIA A, rectal sensation is the key determining factor.

    But what I don't get is how the lack of rectal sensation can imply things about the entire cord below the level of injury.

    The way I see it is that messages travel down the cord, and when they get to where they're going, they stop.

    I would think that if messages are getting to, say, L5, wouldn't you be better off testing for sensation/movement near that area than at the very bottom of the cord?

    How does testing for sensation/movement at the lowest section of the cord imply that no messages are getting below the level of injury?


    Maybe I'm missing something.

    Sincerely,

    Dave
    "Leela, you look beautiful. Incidentally, my favorite artist is Picasso."

    #2
    Dave,

    The ASIA A classification means that there is some level of the spinal cord below which there is no sensation or voluntary function. Since the S4/5 is the lowest spinal cord segment and it is tested by the presence of anal sensation and voluntary anal contraction, a person is an ASIA A only if and when there is absent anal sensation and no voluntary anal contraction.

    Many studies have now shown that absence of S4/5 sensation and voluntary anal sphincter contraction correlate with more severe injuries and less recovery of function than people who have such sensation and movement.

    Note that ASIA B (sensory incomplete) and ASIA C both require the presence of anal sensation or the patient would be classified as an ASIA A.

    Wise.

    Originally posted by pianodave
    Dear all,

    Just thought you might be able to help me understand the ASIA classifications. I saw you put the list up in Ian's thread, and I remembered a question I had about it.

    I understand that for ASIA A, rectal sensation is the key determining factor.

    But what I don't get is how the lack of rectal sensation can imply things about the entire cord below the level of injury.

    The way I see it is that messages travel down the cord, and when they get to where they're going, they stop.

    I would think that if messages are getting to, say, L5, wouldn't you be better off testing for sensation/movement near that area than at the very bottom of the cord?

    How does testing for sensation/movement at the lowest section of the cord imply that no messages are getting below the level of injury?


    Maybe I'm missing something.

    Sincerely,

    Dave

    Comment


      #3
      ". . .and it is tested by the presence of anal sensation and voluntary anal contraction."

      Dr. Young -- does feeling deep pressure during every bowel program count as "sensation?"

      Thanks,

      Comment


        #4
        Unfortunately, it doees not. In ASIA scoring the issue is feeling light touch and/or pin prick on the surface of the skin.

        RAB
        The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

        Comment


          #5
          SCI Nurse:

          Just so that I'm clear, are you saying that even if a person can feel a suppository and/or dig. stim., if they cannot feel light touch or pinprick at the surface then they are ASIA A?

          Comment


            #6
            ASIA Bizzarness

            I've been trying to figure this out for a long time- without success- as a so-called "walking quad" ( I tend to refer to mysef as a perpetually falling quad) (C-3-4 lesion) I have no anal sensitivity - pin prick or light touch- but still have substantial motor ability in the legs- I don't get where this puts me on the ASIA score. My physiatrist wisely suggests I ignore the scale and get back to PT. LOL

            David
            A Conservative government is an organised hypocrisy.
            Benjamin Disraeli

            Comment


              #7
              Brighter, RAB is right regarding the ASIA classification. This of course does not mean that deep rectal sensation is not significant. It is simply a classification system. Wise.

              Originally posted by Brighter days
              ". . .and it is tested by the presence of anal sensation and voluntary anal contraction."

              Dr. Young -- does feeling deep pressure during every bowel program count as "sensation?"

              Thanks,

              Comment


                #8
                Originally posted by DavidHH
                I've been trying to figure this out for a long time- without success- as a so-called "walking quad" ( I tend to refer to mysef as a perpetually falling quad) (C-3-4 lesion) I have no anal sensitivity - pin prick or light touch- but still have substantial motor ability in the legs- I don't get where this puts me on the ASIA score. My physiatrist wisely suggests I ignore the scale and get back to PT. LOL

                David
                David,

                Do you have voluntary contraction of your anal sphincter? If so, you would be an ASIA D. Wise.

                Comment


                  #9
                  Dr. Young,

                  No I don't have control- spastic sphincter.

                  Thanks,

                  David

                  PS Live in Old Bridge and look forward to meeting you at a future open house
                  A Conservative government is an organised hypocrisy.
                  Benjamin Disraeli

                  Comment


                    #10
                    Originally posted by Brighter days
                    SCI Nurse:

                    Just so that I'm clear, are you saying that even if a person can feel a suppository and/or dig. stim., if they cannot feel light touch or pinprick at the surface then they are ASIA A?
                    I'd been wondering about this too. I was classed ASIA A, but as I can sort of feel something going on during bowel program (and also when I have a bowel accident), I thought it might mean I had become ASIA B.
                    But, I cannot feel pinprick/light touch anywhere below injury level, so I guess I still am ASIA A?
                    (I have zero motor function below lesion)

                    Comment


                      #11
                      The ASIA classification system is for medical types to help us to compare one injury to another. It doesn't mean anything beyond that. A person's function is a much better indication of their recovery and accomplishment. ASIA classifications are not grades like you get in school. It's probably just as well to blithely ignore them and get on with living.

                      RAB
                      The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                      Comment


                        #12
                        ASIA Worries

                        RAB

                        Exactly what my Doc said!
                        A Conservative government is an organised hypocrisy.
                        Benjamin Disraeli

                        Comment

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