Zone of Partial preservation ZPP 2019

[Karen C]

I am pretty confused about the new 2019 rule for Zone of Partial Preservation.
Is there an easy way of thinking about it? It seems so confusing in the powerpoint.
I love the easy way to remember Decorticate and Decerebate. (Decorticate hands point to the cortex, decerebate – lots of “E”s for extension)
Is there an easy way of remembering this stuff too?

[Chrissy Durrough Lugge]

Hi Karen,

It is tricky wording! Basically, if deep anal pressure sensation (DAP) is present, then there is NO sensory ZPP. And if voluntary anal contraction (VAC) is present, then there is NO motor ZPP. If either is absent, then there is a ZPP.

Sensory:
– DAP present = ZPP not applicable
– DAP absent = ZPP is lowest dermatome on each side with some light touch or pinprick preservation (assuming LT and PP in S4-5 are scored as 0)

Motor:
– VAC present = ZPP not applicable
– VAC absent = ZPP is lowest myotome on each side with some preservation

[Karen C]

Thanks for the great info! Much easier to understand!
I’d also love to see more videos with examples of scoring ASIA forms, especially with this new ZPP information. Do you have any videos like that or do you recommend any online?

[Karen C]

Also, for someone to have “motor control” in the sacral segments, do they have to have VAC or DAP or both? Is VAC a measure of motor control/motor function and DAP a measure of sensation?

Thank you so much for answering questions! It is so helpful to know that there is someone out there who can reliably answer!

[Chrissy Durrough Lugge]

VAC is a motor assessment and DAP is a measure of sensation. Motor control only requires voluntary anal contraction.

Regarding additional practice videos, I found a couple on YouTube:
1. https://www.youtube.com/watch?v=LErgPVcgHW0
2. https://www.youtube.com/watch?v=ewv3haxxDCc

I haven’t watched either of these in their entirety, but they seem to walk through some more examples of ISNCSCI exams.

[Karen C]

Thanks Chrissy! I saw those already. I am looking for more complicated examples that bring you through ASIA C and D and ZPP for incomplete injuries. There is another video out there, but it has a bunch of errors that were caught by viewers (and one error caught by the person making the video!). I don’t feel like I can trust the videos made by that person.
If you see anything else, please let me know. (I thought there would be a bunch on You tube! I’m actually surprised! Maybe you should make one, Chrissy!!)

[Chrissy Durrough Lugge]

I’ll let you know if I find anything else and may add another example as I am updating the course for 2024-25!

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