Exam 3 question

[Sarah Pinasco]

90. You are evaluating a patient known to have a C7 spinal cord injury. Upon administering the ASIA Impairment Scale (ISNCSCI) instrument, you note the patient has symmetrical strength graded as 4/5 in his hands and hip flexors, 3/5 in his knee extensors and ankle dorsiflexors, and 0/5 in his toe extensors and ankle plantarflexors. Additionally, deep anal pressure is intact. This patient would be classified as an AIS grade:
a. A
b. B
c. C
d. D
The patient has a motor incomplete spinal cord injury with more than 50% of key muscles below the injury having a strength grade of at least 3/5.

Can you explain this further? Since no voluntary Anal contraction is noted how can the patient be classified higher than an ASIA B

Thanks

[Kathleen Trapani]

I am not the author, but my experience with the ASIA is that you are incomplete with either intact anal contraction OR sensation. The patient in this case has intact deep pressure, making them incomplete and then able to be Other than a B. Yes?

[Kathleen Trapani]

Sorry…you have me obsessing now and I’m glad you brought this up…can someone else comment whether this is the issue of not just needing the deep pressure intact but also needing the motor function intact three levels below the injury level?? This tool is tricky when it’s not right on front of you!

[Chrissy Durrough Lugge]

Hi Sarah and Kathleen,

If the patient has deep anal pressure OR voluntary anal contraction OR a score of at least 1 on any S4-5 sensory test, the injury is incomplete. Because deep anal pressure is intact and more than 50% of key muscles below the level of injury are graded as at least 3/5, the patient’s injury is classified as AIS D.

Here is an example ISNCSCI matching this patient’s characteristics: http://rehabknowledge.com/exam-3-isncsci/

Hope this helps!

Chrissy

[Kathleen Trapani]

That helps! Thank you!

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