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I understand that the neurological level of injury is the most caudal level from the motor and sensory levels. In the AISA Practice #3, the sensory level is T10 (R) and T12 (L), but why is the motor level also T10 (R) and T12 (L)? I would think it would be L4 (R) and L3 (L), since all motor levels above are a 5/5.
– Can you explain this same question for AISA practice exams 4 and 5.
Thank you!
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Hi Belen!
This is one of the trickier concepts of the ISNCSCI/ASIA exam. Because there is no myotome testing for the trunk, we have to make assumptions about this region – and the ASIA is standardized to make conservative assumptions. In regions with no formal muscle test (T2-L1), motor function is presumed to be the same as sensory function if testable motor function above that level is also normal. So, even if motor scores are normal in all testable regions, if sensation is impaired between T2 and L1, the motor level is the lowest level with intact sensation. This is also outlined in the Steps to Classification section on page 2 of the PDFs.
If sensation were normal between T2 and L1 for this patient, you are correct that the motor levels would be L4 on the right and L3 on the left.
This is where the ASIA Impairment Scale Grade (AIS A-E) comes in handy to help provide more insight into the patient’s clinical picture. Obviously the patient in practice ASIA 3 with a T10 AIS D injury will function very differently than someone with a T10 AIS A injury. Same with practice cases 4 and 5.
Chrissy
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