Case 9 asia rating

[Heather Cole]

The patient has anal sensation but no motor down there, so I thought he’d rate as asia B with a really big zone of partial preservation. Why is he rated D?

[Chrissy Durrough Lugge]

Hi Heather – Yes, this patient is an AIS B – your reasoning is correct! That is consistent with what I’m seeing on my copy of this practice ASIA exam. Does your version say D?

[Heather Cole]

Hmm. Maybe I’m looking at something else? I tried to attach a screenshot but that didn’t work. I cut and paste from the screen instead. It says D is the right answer. Is this the same thing you have for case 9?

2. A 38-year-old male presents to outpatient physical therapy 6 months after sustaining a gunshot wound that resulted in a spinal cord injury. He is independent with all transfers and drives with hand controls. He uses a manual wheelchair as his primary means of mobility, although he can walk up to 20 feet with a walker and no orthoses. The patient’s primary goal is to improve his gait mechanics and endurance to reduce reliance on his wheelchair.

What is the patient’s ASIA Impairment Scale (AIS) grade?

a. A
b. B
c. C
d. D
At least half of the key muscle functions below the neurologic level of injury have a muscle grade ≥3/5. There are 10 muscle grades in the lower extremities (L2-S1 bilaterally), and 5 of these are graded as at least 3/5 (right L2, right L3, left L2, left L3, left L4).

[Heather Cole]

Ohhh, wait now I’m more confused. There’s a footnote on the ASIA scale:

“For an individual to receive a grade of C or D, i.e. motor incomplete status, they must have either (1) voluntary anal sphincter contraction or (2) sacral sensory sparing with sparing of motor function more than three levels below the motor level for that side of the body. The International Standards at this time allows even non-key muscle function more than 3 levels below the motor level to be used in determining motor incomplete status (AIS B versus C)”

Is this why the guy is rated D?

And also, “sparing of motor function” — does that mean any, like a person could have 3 rows of 1/5 and get rated C, or must the muscles be at least 3/5 to count?

[Chrissy Durrough Lugge]

Hi Heather!

I’m sorry – I was referring to the practice ASIA 9 under the spinal cord injury module. I now see you are referencing case 9 from the practice exams.

This patient’s injury is AIS D. Because he has either intact sensory or motor at the lowest sacral levels, he has an incomplete injury. If he had no motor function below his neurologic level of injury (T7), his intact deep anal pressure would classify him as B. Because he has motor function distal to his injury, he is either an AIS C or D. More than half of the key muscles are graded as >=3/5, so he is an AIS D.

Sparing of motor function means any motor functioning, so grades of 1/5 would count. The cut-off of 3/5 is used to differentiate between C and D.

Chrissy

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