Practice ASIA handouts

[Margaret Frank]

Hi Chrissy

I have a question about ASIA practice handout #3. I got the right neuro level of injury but my motor scores were not correct. I thought the Right motor level was L4 and Left motor level was L3. However, the motor levels were the same as the sensory levels (right was T10, Left was T12).

I was under the impression that the lowest key muscle that has a grade of at least 3 providing that the key muscle segments above are intact (grade of 5)… the segment L2 + L3 were 5 for the right (so I picked L4 for motor level); and the segment L2 was 5 for the left (so I picked L3 for motor level).

I notice that the sensory levels in the thoracic region are not all 2/2; so because of this, we choose the motor level to match with the most intact sensory level? The reason I am confused is because some lumbar segments were 5/5 MMT. But for the grading of the motor levels, if sensory is not 2/2 in thoracic region, then we assume to match the motor with intact sensory level?

I hope this makes sense. Just want to clarify
Thank you so much for your help!
Maggie

[Julie Schwertfeger]

Hi Margaret, I want to endorse your conclusion about your motor level on Practice Case 3. There are no key muscles there, so it is important to verify the highest level where those are intact since they are not intact through to the LE key muscle tests. In this case, we need to fight the urge to take they LE key muscle scores because of the sensory intactness above as you concluded.

[Chrissy Durrough Lugge]

Hi Margaret and Julie,

Margaret, thanks for this question! Julie, you are correct! 🙂

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.

Let me know if I can provide any further clarification.

Thanks!

Chrissy

[Bethany Quattropani]

I was also confused about the motor grading in this example. So then just to clarify, for practice ASIA exam 4…
the motor level for R side is T1, because there is sensory intact at this level and we cannot muscle test at T2? Even though light touch is 2 and pinprick is 0 at T1, this is sufficient sensory function?

Thank you!

[Chrissy Durrough Lugge]

Hi Bethany,
There is a motor test at T1 (finger abductors) that is graded 5/5, so we know the motor level will be T1 or lower. Because sensation is impaired at T1, we don’t make the assumption that motor in intact at T2 – so the motor level is T1. Does that make sense?
Chrissy

[Rachel Nelson Saunders]

In this case, why would the motor level not match the intact sensory level? Ie, why is it not C8 where sensation is intact, whereas at T1 sensation scores are 2 and 0?

Thanks!

[Chrissy Durrough Lugge]

Hi Rachel,
We have a muscle test at T1 to confirm motor function is intact at that level, which is what the motor score is assessing. We make assumptions about motor matching sensory when there is no corresponding motor test (levels T2-L1). A manual muscle grade of 5/5 in the finger abductors (T1) trumps impaired sensation at T1 for determining motor level.
Chrissy

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