Standard Neurological Classification of Spinal Cord Injury - PowerPoint PPT Presentation

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Standard Neurological Classification of Spinal Cord Injury

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    1. Standard Neurological Classification of Spinal Cord Injury by Greg Nemunaitis, MD

    4. Vertebral artery

    9. Tetraplegia: The impairment or loss of motor and/or sensory function in the cervical segments of the spinal cord due to damage of neural elements within the spinal canal. Paraplegia: The impairment or loss of motor and or sensory function in the thoracic, lumbar, or sacral segments of the spinal cord due to damage of neural elements within the spinal canal. Dermatome: The area of skin innervated by one sensory nerve root. Myotome: The collection of muscles innervated by one motor nerve root.

    10. Neurological Level of Injury: The most caudal segment of the spinal cord with normal motor and sensory function on both sides. Skeletal Level: The radiographic level of greatest vertebral damage.

    11. Incomplete Injury: If there is preservation of motor and or sensory function in the lowest sacral segment. Complete Injury: The absence of motor and/or sensory function in the lowest sacral segment. Zone of Partial Preservation: Dermatomes and myotomes caudal to the neurological level that remain partially innervated (this term is only used in complete injuries).

    14. ASIA Sensory Testing Sensory Testing: 0 = Absent 1 = Impaired 2 = Normal NT = Not testable

    15. ASIA Dermatones C2-Occipital Protruberance C3 –Supraclavicular fossa C4 – A.C. Joint C5 – Lateral antecubital fossa C6 – Thumb C7 – Middle finger C8 – Little finger T1 – Medial antecubital fossa T2 – Apex of the axilla T4 – Nipple line T6 – Xyphoid T10 – Umbilicus T12 – Inguinal ligament L2 – Mid thigh L3 – Medial femoral condyle L4 – Medial Malleolus L5 – 3rd MTP joint S1 – Lateral heel S2 – Mid popliteal fossa S3 – Ischial tuberosity S4-5 – Perianal area

    17. ASIA Motor Testing 0 = No movement 1 = Trace contraction 2 = Full AROM gravity eliminated . 3 = Full AROM against gravity 4 = Full AROM against gravity with resistance 5 = Normal power NT

    18. ASIA Myotomes C5 – Elbow flexors C6 – Wrist extensors C7 – Elbow extension C8 – Finger flexors T1 – 5th digit abduction L2 – Hip flexion L3 – Knee extension L4 – Ankle dorsiflexion L5 – Long toe extension S1 – Ankle plantar flexion

    20. ASIA Impairment Scale Spinal Cord Medicine Principles and Practice Vernon Lin: Count the number of key muscles below the neurologic level for each side of the body If less than ½ have a motor score of 3 or more then AIS grade is C, if ½ or more have a motor score of 3 or more then AIS grade is D. ASIA Reference Manual Complete Injuries: The absence of motor and sensory function in the lowest sacral segment Zone of Partial Preservation: dermatomes and myotomes caudal to the neurologic level of injury that remain partially innervated ASIA D at least ½ of the key muscles below the neurologic level of injury have a grade 3 or better ASIA C must have motor function in 3 or more segments below the level of injury The presence of voluntary contraction of any muscle (even non-key muscles including the anal sphincter) indicates an AIS score of C ASIA C motor function must extend more than two levels caudal to the motor level of injury International Standards for Neurological Classification of SCI 2002: ASIA C or D must be incomplete and have sparing of Motor function more than 3 levels below the motor level or have voluntary anal contraction. ASIA IScOS form: ASIA D at least half of the key muscles below the (single) neurological level are grade 3 or better

    24. ASIA Impairment Scale A = Complete: No motor or sensory function in the lowest sacral segment. B = Incomplete: Sensory but not motor function is preserved in the lowest sacral segment. C = Incomplete: Less than ½ of the key muscles below the (single) neurological level have a grade 3 or better. D = Incomplete: At least ½ of the key muscles below the (single) neurological level have a grade 3 or better. E = Sensory and motor function are normal.

    25. Snappers ASIA C in addition to being incomplete, must have motor function more than 3 levels below the motor level on a given side. The presence of voluntary contraction of any muscle (even non-key muscles including the anal sphincter) can indicate an AIS score of C.

    26. Clinical Syndromes Central Cord Syndrome: Cervical injury with sacral sparing and greater weakness in the arms than the legs. Brown-Sequard Syndrome: An injury that causes greater ipsilateral weakness and proprioceptive loss and contralateral pain and temperature loss. Anterior Cord Syndrome: Injury to the spinal cord causing loss of pain and temperature sensation with preserved proprioception. Posterior Cord Syndrome: Injury to the spinal cord causing loss of proprioception with preserved pain and temperature sensation. Conus Medullaris Syndrome: Injury of the sacral conus and lumbar nerve roots Cauda Equina Syndrome: Injury to the lumbosacral nerve roots within the neural canal.