ASIA Scale

ASIA motor exam

specific key extremity muscles tested in supine only

1. bilateral myotomes (C5, C6, C7, C8, T1, L2, L3, L4, L5, S1)

2. sacral motor tested with voluntary anal contractions (VAC)

*ask individual if they are able to stop a bowel movement

GRADING:

0 = absent

1 = trace to less than full range in gravity-eliminated

2 = full ROM gravity eliminated

3 = full ROM against gravity w/o resistance

4 = full ROM against gravity w/ some resistance

5 = full ROM against gravity full resistance

NT or 5* = pain or disuse vs not testable

ASIA motor exceptions/special requirements

- contracture (grade normally if has at least 50% normal PROM)

- spasticity (use NT if severe, clonus, impaired SVC)

- if pain, disuse or weakness limit testing session, examiner can use 5* to indicate clinical judgement of full innervation

lowest level with both modalities intact (score of 2) (ex. if C2 is a 1, then sensory level is C1)

How do you determine the sensory level?

find the lowest level where all grades rostral are 5

How do you determine the motor level?

use the sensory level for the motor level (if all levels above are intact - 5)

How should you assign a motor level if the segment is presumed is not one of the myotomes that is tested?

neurological level of injury (NLI)

lowest level at which motor and sensory are intact

*helps predict function

complete (SCI)

absence of sensory AND motor function at S4/5

*reads "NOOOON" at the S4/5 boxes on the scoring form

incomplete (SCI)

sacral sparing

- sensory incomplete (AIS B)

- motor incomplete (AIS C or D)

AIS A

complete injury

- absence of VAC, DAP, AND sensory at S4/5

- may have a zone of partial preservation (ZPP)

zone of partial preservation (ZPP)

most caudal level with some preservation

- record R and L sides

- do NOT use non-key mm

MOTOR--> VAC must be absent

SENSORY--> DAP must be absent

*if either VAC or DAP is present, use NA for both sides

AIS B

sensory incomplete

- must have: sensory to light touch, pin prick at S4/S5 OR deep anal pressure (DAP)

- may not have VAC - if VAC is present, score as AIS C or D

*may have a zone of partial preservation (ZPP)

AIS C/D

motor incomplete

- MUST: VAC OR sensory S4-S5 (or DAP) AND more than 3 motor levels below the motor level for that side (key and non-key mm)

C = 1/2 or more of the key mm have a grade less than 3

D = more than 1/2 of the key muscles have a grade of 3 or higher

*may have ZPP

D

Is AIS C or D "better" (higher functioning)?