The American Spinal Injury Association, also known as ASIA, has a protocol to asses and classify spinal cord injuries extent and severity.
ASIA Impairment scale
This protocol is called the International Standards for Neurological Classification of Spinal cord injury (ISNCSCI), but sometimes is referred to as ASIA impairment scale, or simply, ASIA exam.
The protocol is a neurological exam widely used to document sensory and motor impairments following spinal cord injury,
in other words, the exam is used to determine where the patient’s spinal cord was damaged and how severe is the damage.
Once a complete ASIA exam is carried, it is possible to determined future rehabilitation and recovery needs. This exam should be,
ideally, completed within 72 hours after the initial injury.
Severe swelling, fractures, pain, and cognitive changes might difficult testing, nonetheless, a partial exam is still helpful in order to better understanding the extent of the injury.
In the Asia exam the patient’s grade is based on how much sensation can feel at multiple points on the body, as well as tests of motor function.
The ASIA scale is graded as follows:
a complete injury, that means there isno motor or sensory function preserved below the level of injury.
a sensory incomplete injury with sensory but not motor function preserved below the level of injury.
a motor incomplete injury withsome motor function preserved below the level of injury, but less than a half the muscles tested below the level of injury are antigravity
a motor incomplete injury with a motor function preserved below the level of injury and at least half of the key muscles below the injury level are antigravity.
Normal. No motor or sensory deficits.
How to calculate ASIA Scores?
The ASIA exam consists on several exams used to determine the following:
Completeness of the injury
Neurological level of injury.
Consists in the examination of 28 different key skin areas which are directly connected with spinal nerves, these areas are called dermatomes.
The test involves light touch with cotton tip applicators and pinprick sensory scoring.
Consists in the examination of 10 key muscle groups in supine position,
the muscle strength is graded as follows:
(5/5) Full range of motion with Full Strength,
(4/5) Full range of motion against resistance,
(3/5) Full range of motion against gravity,
(2/5) Full range of motion with gravity eliminated,
(1/5) Muscle flickers butunable to move against gravity,
(0/5) No muscle activity detected.
Completeness of the injury
Spinal cord injury can be complete or incomplete.
In complete Injuries the spinal cord has been completely severed at the site of the injury, resulting in the elimination of function for all spinal cord nerves below the site of the injury.
On the other hand, in incomplete Injuries the spinal cord is partially severed or damaged.
In this case, there may still be function for some nerves below the site of the injury.
Neurological level of injuries
The spinal cord is surrounded by bones called vertebrae.
Usually spinal cord injury also implies damage to the vertebrae; thus, vertebrae are particularly useful as references to determined where the damage is.
Level of injury refers to place of the vertebrae affected.
These bones are grouped into four sections.
As a rule, the closer to the head the spinal cord injury is, the more dysfunction can occur.
Level of injury are classified as follows:
Cervical Injury (damage between C1 to C7)
Spinal cord injury between C1 to C7 are the most severe levels, damage in those vertebrae can result in paralysis in :
besides breathing, bowel or bladder control are usually affected, speak is sometimes impaired or reduced.
A person with this level of injury requires complete assistance with activities of daily living.
Thoracic Injury (damage between T1 to T12)
Spinal cord injury between T1 to T12 usually result in paraplegia, that means the injury affect the trunk and legs.
A person with this level of injury usually have normal arm and hand function, and sometimes even normal upper-body movement.
Most likely to use a manual wheelchair and even drive a modified car.
Lumbar Injury (damage between L1 to L5)
Spinal cord injury between L1 to L5 generally result in some loss of function in the hips and legs, with little or no voluntary control of bowel or bladder.
Depending on strength in the legs, may need a wheelchair and may also walk with braces.
Sacral Injury (damage between S1 to S5)
Spinal cord injury between S1 to S5 generally result in some loss of function the hips and legs,
with little or no voluntary control of bowel or bladder.
Most likely will be able to walk, with or without special equipment.