Sci Asia Scale PPT (Final)

SPINAL CORD
INJURY
(ASIA SCALE)
-SCI is a relatively low-incidence, high-cost injury that results in
tremendous changes in an individual’s life.
-SCI is divided into two broad etiological categories:
TRAUMATIC and NON-TRAUMATIC.
TRAUMATIC SCI
Traumatic injury results from damage caused by events such as
motor vehicle accidents (38%), falls (30.5%), violence (13.5%),
and sports- related injuries (9%).
NON-TRAUMATIC SCI
Non-traumatic injuries results from diseases or pathological
influences.
Conditions that may damage the SC are spinal stenosis; spinal
neoplasm; syringomyelia; multiple sclerosis.
Classification of SCI
-SCI typically is divided into two broad functional categories:
Tetraplegia and Paraplegia.
-Tetraplegia refers to motor and/or sensory impairment of all four

extremities and trunk, including the respiratory muscles, and
results from lesions of the cervical cord.
-Paraplegia refers to motor and/or sensory impairment of all or

part of the trunk and both lower extremities, resulting from lesions
of the thoracic or lumbar spinal cord pr cauda equina.
Designation of Lesion Level
■ American Spinal Injury Association (ASIA) created the

International Standards for Neurological Classification
of Spinal Cord Injury (ISNCSCI)
■ ISNCSCI provides a standardized examination method to
determine the extent of motor and sensory function loss
after a SCI.
ASIA Impairment Scale
■ Individuals with incomplete injuries may have variable

clinical presentations in terms of motor and/or sensory
function below the neurological level.
■ he ASIA impairment scale was created so that clinicians
and researchers could better communicate the degree of
motor and sensory impairment of individuals with SCIs.
Components of ASIA
■ Sensory level of lesion

■ Motor level of lesion
■ Neurological level of lesion
■ Zone of partial presentation of sensation
■ Categorizing them into complete and incomplete injuries.
Sensory level of lesion-
■ Sensory level is referred to as the most caudal segment of the
spinal cord with normal sensory function bilaterally.
■ Sensory level is determined by testing the patient’s sensitivity to
light touch and pinprick on the left and right side of the body at
key dermatomes
■ Sensory examination is done on 28 dermatomes on each half of the
body
■ On key points ( specific point on dermatomes which is innervated
by single spinal nerve)
■ Sensory level is determined by testing the patient’s sensitivity to
light touch and pinprick on the left and right side of the body at
key dermatomes
Scoring of sensation
■ Scoring of sensation is based on a 3-point ordinal scale
where 0 = absent, 1 = impaired, and 2 = normal.
■ Motor level is determined by testing the strength of a key
muscle on the right and left side of the body at myotomes
adjacent to the suspected level of impairment.
■ Key muscle strength is scored using the 6-point ordinal
scale commonly used for manual muscle testing.
DERMATOMES LOCATION
C2 Posterior ear lobe
C3 Adams apple
C4 Above acromion
C5 Lateral part of arm
C6 Lateral part of forearm
C7 Fingers (index)
C8 Tip of little finger
T1 Medial surface of arm
T2 Anterior axillary fold
T3 Point between axillary fold and nipple level
T4 Nipple level
T10 Umbilicus level
T11
T12
DERMATOMES LOCATION
L1 Ilioinguinal and groin area
L2 Medial surface of thigh
L3 Knee joint crease
L4 Medial malleolus
L5 Point between great toe and second toe
S1 Sole of foot ( calf area)
S2 Posterior of thigh(popliteal fossa)
S3 Buttock area
S4 Area around sphincter
S5 Sphincter
Motor level of lesion-
■ Motor level is referred to as the most caudal segment of

the spinal cord with normal motor function bilaterally.
■ Motor level is determined testing the strength of 10 key
muscles on the right and left side of the body.
■ Motor examination is done on key muscles bilaterally on
UL AND LL
■ Check for strength (MMT) on both sides
Spinal cord segment Muscle Actions
C5 Biceps Elbow flexion
C6 Extensor digitorum communis Wrist extension
C7 Triceps Elbow extension
C8 Flexor digitorum Finger flexion

profundus/superficialis
T1 Digiti minimi Little finger abduction
L2 illiopsoas Hip flexion
L3 Quadriceps Knee extension
L4 Tibialis anterior Ankle dorsiflexion
L5 Extensor hallucis longus Great toe extension
S1 Gastronemeus Ankle plantarflexion

Neurological level of lesion-
■ The neurological level of injury is defined as the most

caudal level of the spinal cord with normal motor and
sensory function on both the left and right sides of the
body.
■ In this the examination of both sensations like light touch
and pin prick and motor examination (MMT) bilaterally on
UL and LL
Zone of Partial Preservation
■ If an individual has motor and/or sensory function below

the neurological level but does not have function at S4 and
S5, then the areas of intact motor and/or sensory function
below the neurological level are termed zones of partial
preservation.
Complete Injuries, Incomplete Injuries, and
Zone of Partial Preservation
■ The ISNCSCI defines a complete injury as having no
sensory or motor function in the lowest sacral segments (S4
and S5) with no sacral sparing.
■ An incomplete injury is classified as having motor and/or
sensory function below the neurological level including
sensory and/or motor function at S4 and S5 with presence
of sacral sparing.
■ Sacral Sparing – It is determined by sensory function at S4-
5 dermatome, voluntary anal sphincter contraction.
Clinical syndromes-
■ Approx. one–fifth of SCI results in injury pattern similar to

clinical SCI syndromes
■ Information related to anticipated sensory and motor
functions of these syndromes are useful in establishing
anticipated goals expected, outcomes and plan of care.
Central Cord syndrome
■ Central cord syndrome is the most common SCI syndrome

■ Generally occurs from hyperextension injuries to cervical
region
■ There is characteristically more severe neurological
involvement of UE than LE (lumbar and sacral tracts
present more peripherally)
Brown-Sequard Syndrome
■ Brown Sequard syndrome occurs from hemi-section of

spinal cord (damage to one side) .
■ Typically caused by penetration wounds that is gunshot or
stab injury.
■ Damage to one side of the spinal cord, resulting in a
combination of paralysis and loss of sensation on the
affected side of the body
Anterior Cord Syndrome
■ Anterior cord syndrome occurs when the anterior portion of

the spinal cord and vascular supply from anterior spinal
artery is damaged
■ This syndrome typically results from spinal cord
compression or injury to the anterior spinal artery.
■ This syndrome leads to paralysis and loss of sensation below
the level of injury, with preserved sensations of temperature
and touch.
Posterior cord syndrome
■ Posterior cord syndrome is a rare condition caused by

damage to the back portion of the spinal cord
■ This syndrome is often associated with trauma or
conditions affecting the posterior spinal arteries.
■ This syndrome results in loss of proprioception (awareness
of body position) and vibratory sensation, while motor
function and pain sensation remain intact.
Conus Medullaris Syndrome
■ Conus medullaris syndrome refers to a neurological

condition caused by injury or compression of the conus
medullaris, the terminal portion of the spinal cord.
■ It can result from spinal trauma, tumors, or conditions
affecting the lower spinal cord.
■ Produces weakness of pelvic organ
Cauda Equina Injuries
■ .Cauda equina lesions are frequently anatomically
incomplete owing to the great number of nerve roots
involved and the comparatively large surface area they
encompass.
■ Individuals with cauda equina injuries exhibit areflexic
bowel and bladder and saddle anesthesia
■ Cauda equina lesions are peripheral nerve (lower motor
neuron [LMN]) injuries.
PRE/POST TEST-
1. Write 4 conditions that may damage spinal cord
2. ISNCSCI stands for
3. Define sensory level of lesion
4. Define neurological level of lesion
5. Posterior spinal artery gets affected in which clinical syndrome
of SCI
6. Write total number of dermatomes in both UL and LL
7. Define central cord syndrome
8. Write Grade A of ASIA scale
9. Scoring of sensation grade 1 represents
10. Write 3 components of ASIA
References:
■ SUSAN B. O’ SULLIVAN PYSICAL REHABILITATION

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Presentation by : Anushka Biyani,

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Sci Asia Scale PPT (Final)

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SPINAL CORD

-Tetraplegia refers to motor and/or sensory impairment of all four

-Paraplegia refers to motor and/or sensory impairment of all or

■ American Spinal Injury Association (ASIA) created the

■ Individuals with incomplete injuries may have variable

■ Sensory level of lesion

■ Motor level is referred to as the most caudal segment of

C5 Biceps Elbow flexion

C6 Extensor digitorum communis Wrist extension

C7 Triceps Elbow extension

C8 Flexor digitorum Finger flexion

L2 illiopsoas Hip flexion

L3 Quadriceps Knee extension

L4 Tibialis anterior Ankle dorsiflexion

L5 Extensor hallucis longus Great toe extension

S1 Gastronemeus Ankle plantarflexion

■ The neurological level of injury is defined as the most

■ If an individual has motor and/or sensory function below

■ Approx. one–fifth of SCI results in injury pattern similar to

■ Central cord syndrome is the most common SCI syndrome

■ Brown Sequard syndrome occurs from hemi-section of

■ Anterior cord syndrome occurs when the anterior portion of

■ Posterior cord syndrome is a rare condition caused by

■ Conus medullaris syndrome refers to a neurological

■ SUSAN B. O’ SULLIVAN PYSICAL REHABILITATION

Presentation by : Anushka Biyani,

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