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OVER 96% PASS RATE FOR THE NCS, OCS, AND PCS EXAMS forums NCS Advantage (CURRENT) Question for SCI Module- Practice ISNCSCI #1

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    • #475870

      Hey all, I hope your studying has been going well. I am reviewing SCI module for the second time and keep getting hung up on the slide 5.49. Can anyone clear up my confusion on why the L Motor neurological level is not C5, if it meets the same “exception” to the standard of determining the motor level, meaning the motor level is assumed to be the same as the sensory level because it does not meet the requirement of having at least a muscle grade of 3/5 in any of the key muscles. (just like the explanation stated when identifying the motor neurological level of the R side) The chart at the bottom names the motor level for for the L side as C4 not C5, even though the sensory level C5. Either way the Neurological LOI is C4 since it is the most cephalad. It is driving me NUTS! TIA !

    • #475873
      Chrissy Durrough
      Keymaster

      Hi Erika! I hope I can help with this! The motor level is defined as “the lowest key muscle function that has a grade of at least 3, providing the key muscle functions represented by segments above that level are judged to be intact (graded as a 5).” In this example, the patient’s elbow flexors (C5) were graded as 2/5, so this cannot be the motor level. There is no formal motor test for C4 on the ISNCSCI; therefore, we assume the motor level is the same as the next highest level with intact sensation. Sensation is normal at C4, which is why the motor level on the left is presumed to be C4. Let me know if I can provide any more clarification!
      Chrissy

    • #475888

      yes it is helpful, another question; pratice ISNCSCI #4 and #5 all have key muscles as scoring 5/5 on the R sides. Practice #4 says the motor level on the R side is T1, Practice #5 says the motor level is T6. It looks like in #4 T1 was chosen as motor level because that is is the my caudal segement with a score of at least 3/5 with the levels above meeting the criteria of 5/5. in #5 the it seems like the motor level of T6 was chosen because the most caudal segement with strength being at least 3/5 is S1 BUT because there are no muscle grades for T2-L1 we cannot say that the levels above S1 meet the standard for being 5/5, therefore we have to use the most caudal sensory level that is intact, which is T6. If my logic is correct- then why does it appear the rules are different for practice #4 ?? Why wasnt the motor level assumed to be the most caudal segement with intact sensation, since S1 is technically the lowest segment with a grade of at least 3/5 for strength BUT again because of no grades for T2-L1, wouldn’t the motor level be assumed as the sensory level, just as in the case of #5???

    • #475898
      Chrissy Durrough
      Keymaster

      In both of these cases, we have to refer to sensation scoring to determine motor level even though strength is 5/5 in all key muscles. Practice ISNCSCI 4 appears to follow “different rules” because there are key muscles for the most caudal segments with intact sensation. Even though the lowest level with intact sensation is C8, we know motor is intact to at least T1 as determined by muscle testing of the finger abductors. Sensation is impaired at T1 and in all distal segments, so the motor level is T1. You described the rationale for Practice ISNCSCI 5’s scoring well. If there is testable motor function available, then the motor scores will supersede sensory scores for determining motor level.

      Here is a previous discussion forum chain regarding Practice ISNCSCI 4 that might also help: https://rehabknowledge.com/forums/topic/isncsci-practice-4/

      Let me know if you have any other questions!

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