ASIA SCALE
Individuals with incomplete injuries may have variable clinical presentations in
terms of motor and/or sensory function below the neurological level.
For example, one patient may have close to normal sensory and motor
function below the level of the lesion whereas another with the same lesion
level may have impaired sensation and no motor function below the
neurological level.
The ASIA impairment scale was created so that clinicians and researchers could
better communicate the degree of motor and sensory impairment of individuals
with SCIs.
The neurological level is defined as the most caudal level of the spinal cord
with normal motor and sensory function on both the left and right sides of the
body.
Motor level is referred to as the most caudal segment of the spinal cord with
normal motor function bilaterally.
Sensory level is determined by testing the patient’s sensitivity to light touch
and pinprick on the left and right side of the body at key dermatomes.
Scoring of sensation is based on a 3-point ordinal scale where 0 = absent, 1 =
impaired, and 2 = normal.
Motor level is determined by testing the strength of a key muscle on the right
and left side of the body at myotomes adjacent to the suspected level of
impairment.
Key muscle strength is scored using the 6-point ordinal scale commonly used
for manual muscle testing.
For the purpose of determining motor and neurological level, the key muscle is
defined as having intact innervation if it has a manual muscle test score of at
least 3/5 (fair) and the next most rostral key muscle exhibits 5/5 (normal)
strength on the manual muscle test.
In determining neurological level there may be differences in terms of level of
sensory and motor function and between the left and right sides of the body.
A complete injury as having no sensory or motor function in the lowest sacral
segments (S4 and S5).
Sensory and motor function at S4 and S5 are determined by anal sensation
and voluntary external anal sphincter contraction.
An incomplete injury is classified as having motor and/or sensory function
below the neurological level including sensory and/or motor function at S4 and
S5.
If an individual has motor and/or sensory function below the neurological level
but does not have function at S4 and S5, then the areas of intact motor and/or
sensory function below the neurological level are termed zones of partial
preservation.
Steps of score ASIA scale:
Step 1: Decide Complete/Incomplete Injury
Check bulb cavernous reflex,anal sensations and voluntary anal contraction and
accordingly decide weather the SCI is complete or incomplete.
Step 2: Decide sensory level
Check pinprick and light touch on both sides, and decide sensory level ( the
caudal most segment where light touch and pinprick sensations are intact on
both sides.
Step 3: Decide motor level
Check MMT of key muscles
Step 4: Asia impairment score
It can be either A,B,C,D,E
ASIA Impairment Scale
A = Complete:No motor or sensory function is preserved in the sacral segments
S4 to S5.
B = Incomplete:Sensory but not motor function is preserved below the
neurological level and includes the sacral segments S4 to S5.
C = Incomplete:Motor function is preserved below the neurological level, and
more than half of key muscles below the neurological level have a muscle grade
less than 3.
D = Incomplete: Motor function is preserved below the neurological level, and
at least half of key muscles below the neurological level have a muscle grade of
3 or more.
E = Normal:Motor and sensory function is normal.
Clinical Syndromes Central cord ,Brown-Sequard ,Anterior cord ,Conus
medullaris ,Cauda equina