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American Spinal Injury Association (ASIA) Impairment Scale

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    #31
    bump

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      #32
      the reason Seneca bumped this is that we were discussing complete , Asia scale etc .the way i read this , it is possible to be ASIA A , ie complete , and yet be a walker . or maybe 2 grades on the scale , ASIA A and ASIA C ? [img]/forum/images/smilies/biggrin.gif[/img] and i am talking from experience here . basically what i am saying , is don't get into a sweat over the complete/incomplete thing .
      thank you ,
      dogger

      every day i wake up is a good one .
      Every day I wake up is a good one .

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        #33
        Thanks Dogger. It was my understanding that it's not function/sensation below the level of injury that determines incomplete status but the ability to sense or contract the anal sphincter. A walker with sacral sparing would be incomplete whereas a walker without sacral sparing would be complete?

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          #34
          The anal sphincter is the lowest (S4/5) segment of the spinal cord. If you have no anal sensation or voluntary contraction of the sphincter from a spinal cord injury and you can walk, that means that you have a complete spinal cord injury at S4. Wise.

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            #35
            Thanks Dr. Young, that's what I thought. [img]/forum/images/smilies/smile.gif[/img]

            Another question; If a person has a cervical lesion at say C6, with no sphincter control or sensation, but can walk, would that person be considered a C6/S4 or just a S4?

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              #36
              Wise , in my case [ walking with no anal voluntary control/sensation] makes me a complete S4 .how does me lacking triceps affect this please ?
              thank you ,
              dogger

              every day i wake up is a good one .
              Every day I wake up is a good one .

              Comment


                #37
                cjo, dogger, seneca, the questions that are being asked are illustrating the limitiations of the ASIA classification. Here is my best understanding of what the definitions mean.

                1. The definition of "incomplete" is the presence of perianal sensation to touch and pinprick. It does not refer to deep anal or rectal sensation. A person with deep rectal sensation only would not be classified as "incomplete", i.e. they lack perianal sensation to touch or pinprick or voluntary sphincter contraction. The question that has not been answered is whether a person with rectal sensations would be classified as "incomplete". Certainly, it could be regarded as such but it would not fit with the ASIA definition.

                2. The level of injury is defined as the lowest level that has "normal" sensation that could be attributed to that level. Note that this definition differs from the criterion that most neurosurgeons and orthopedic surgeons uses, that the neurological level represents the lowest level that has any sensation. When the ASIA committee debated this issue, we agreed to accept the definition that was accepted by most rehabilitation doctors, that the neurological level represent the lowest level where there is normal sensation. There may be some sensation or function below that level that the neurological level remains the lowest segmental level with *normal* function.

                Thus, in the case of Dogger where he does not have good triceps function (C7), his injury level remains at C6 (assuming that he has good sensory and motor function at C6. However, he has substantial function below that level because he can walk. He does not have anal sphincter contraction or sensation, and therefore remains an ASIA A.

                Wise.

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                  #38
                  A person is ASIA C if the person has at least sacral sensation and any motor function below the neurological level but less than half of the key muscles below the neurological level have a muscle grade of 3 or greater.
                  Dr. Young, I wanted to nit-pick your statement in the original post just in case it caused anybody any confusion....sorry....shouldn't the statement be less than 3?

                  Comment


                    #39
                    whether it is true or not most emergency neurologists would consider the lack of anal sensation a bad omen for recovery potential. Is it just statistics show that those admitted withou sacral sensation make less degree of recovery? While I was at NYU in 1999, they treated it as if you are indeed complete by this definition, rehab's goals are not directed toward's making recovery.

                    sherman brayton
                    sherman brayton

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                      #40
                      dr. young-
                      so if I have my last normal sensation at vetrebral level T12, and I had an AVM just above the Conus, where is that at the spinal cord level?

                      sherman brayton
                      sherman brayton

                      Comment


                        #41
                        mattc, I apologize for the double negative in the statement... please read it again: "Less than half of the muscles have a score of three or greater"... means that half or more of the muscles have scores less than 3. Wise.

                        Comment


                          #42
                          Sherman, for most of my career, I have been arguing against applying the label of "complete" to people. It is inappropriate scientifically, clinically, and psychologically. We know that

                          1. Scientifically, absence of function below the injury site does not mean absence of axons or connections, only that there is not sufficient connections to reach a threshold for activity.

                          2. Clinically, as many as 20-25% of people with so-called "complete" spinal cord injury and particularly when treated with methylprednisolone become "incomplete" over time (i.e. convert from ASIA A to ASIA B or C).

                          3. Psychologically, the label of "complete" injury becomes a self-fulfilling prophecy. People who believe that they will not recover will not only not try to recover but deny the possibility of recovery.

                          Regarding your level... it depends on the neurological findings. That is why I keep asking you what sensation and motor function you have. When you say that your last normal sensation is at vertebral level T12, that does not make sense. Use the dermatomal map below and figure out your sensory level is. And please, figure out your motor level. Can you feel down to your knees... if so, your sensory level may be at L3, for example.

                          Comment


                            #43
                            Like many others I am trying to understand how to figure out the ASIA score of Dennis, C5 diagnosed as complete.

                            He seems like a classic C5 in terms of function, but does have some sensation below level of injury on the right side, not the same as pre-SCI, but some - down to his toes.

                            My question on ASIA rating has to do with the fact he knows when he has to have a BM and can feel when it happens, and also can 'feel' when he has his suppository as part of his BP.

                            Does this mean he may not be complete? And possibly ASIA B, not ASIA A?

                            Thanks Wise,
                            Meg

                            Comment


                              #44
                              The injury is named after the lowest segment with NORMAL SENSATION
                              &
                              A MUSCLE GRADE OF 3 OR BETTER


                              So if someone has movement at C5 with a grade 3 or better, but not below this, they would be called C5 even if they have have normal sensation. The fact that he has bowel and bladder (and genital???) sensation, even if not normal, would indicate an ASIA B at least, since this requires some sensation below the level of injury that includes the peri-anal (around the anus) sensation.

                              (KLD)
                              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


                                #45
                                KLD, thanks very much for pointing that out. A muscle grade of 3 is considered normal for a segment because almost all muscles are shared between two segments. Therefore, if the C5 dermatome has normal sensation and the biceps (which is innervated by C5 and C6) is a grade 3 or better, the person has a C5 injury level.

                                Meg, I agree with KLD. The fact that Dennis can feel a suppository being placed suggests that he has rectal and anal sensation. If he can (and it is not just some indirect feeling) feel touch or pinprick around his anus, this would mean that he is an ASIA B. This is also consistent with his having feeling down to his toes on the right side. He may even be an ASIA C if he has voluntary motor function that is more than one segment below his neurological level. This is where the ASIA classification system is vague. The original scale developed by Hans Frankel, called the Frankel scale, upon which the ASIA scale is partly based, the C classification is assigned only if there is non-useful motor function in some leg muscle. The ASIA scale does not distinguish between arms and legs muscles. Therefore, if Dennis gets back finger movements (C8), this would mean that he would be considered an ASIA C.

                                Christopher Reeve started off as an ASIA A with a C2 neurological level. At about 2 years after injury, he began to notice that he can feel a suppository inserted during his bowel routine. Over time, he became so sensitive that this would bother him and they had to use lidocaine jelly when they did his routine. His son Will also noticed that he could attract his father's attention when he slapped his father's hand. So, Christopher was at least an ASIA B. Over 3-5 years, he continued to get back more sensory function so that he has sensation over perhaps as much as 3/4 of his body, down to his knees. In addition, he found that he could shrug his shoulders, move his left index finger, and voluntarily move his hip flexors sufficiently to lift a 5-pound weight with either leg in a swimming pool. He, however, still cannot move his biceps. Therefore, Christopher currently has a C4 neurological level and an ASIA C classification.

                                Wise.

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