Spinal Cord Injury Level and Function

1 Spinal Cord Injury Level and Function Dr Wunna Aung SCI rehabilitation Consultant The Spinal Cord Anatomy Function Anatomy Spinal segment Spinal cord segment Level relative to vertebral bodies Function Major conduit through which information travels between brain and body. Sensation Motor Blood Pressure Bladder Bowel Sexual Function Assessment of SCI. AIS (American Spinal Injury Association ASIA Impairment Scale). Level of Injury Completeness of Injury - A, B, C, D, E. Dermatome=area of the skin innervated by the sensory axons within one segmental nerve (root). Myotome=collection of muscle fibers innervated by the motor axons within one segmental nerve( root). Dermatomes Myotomes Sensory testing Soft touch and pin prick Dermatomes Sensory Scoring 0 Absent 1 Altered 2 Normal ASIA. Chart ? ? ? ? ? ASIA. Chart C4. T4 (nipples). T6 (xiphisternum). ? ? ASIA. Chart C4. T4. T6 (xiphisternum). T10 (umbilicusicus). ? ASIA. Chart C4. T4. T6 (xiphisternum).

2 T10 (umbilicusicus). T12 (Inguinal ligament). Motor examination Motor power of key muscles MRC Motor Scores 0 None 1 Flicker 2 Movement, gravity eliminated 3 Movement, against gravity 4 Movement, against resistance 5 Full Power Key muscles C5 - Elbow flexion (biceps). C6 - Wrist extension (extensor carpi radialis). C7 - Elbow extension (triceps). C8 - Finger flexion ( flexor digitorum profundus). T1 - Small finger abductors (abductor digiti minimi). L2 - Hip flexion (iliopsoas). L3 - Knee extension (quadriceps). L4 - Ankle dorsiflexion (tibialis anterior). L5 - Great toe extension (extensor hallucis longus). S1 - Ankle plantar flexion (gastrocsoleus complex). Per rectal examination Deep anal sensation Bulbo-carvernosus reflex Voluntary anal contraction ASIA Chart Upper Limb and Trunk Date Time Motor Touch Pain MOTOR R L R L R L. Shoulder Elevators C3, 4 2 2 2 2 C2. Abductors C5, 6 2 2 2 2 C3. Adductors C5-T1 2 2 2 2 C4. Elbow Flexors C5,6 5 5 2 2 2 2 C5.

3 Elbow Extensors C7, 8,T1 3 3 2 2 2 2 C6. Wrist Flexors C6,7,8 2 1 1 1 C7. Wrist Extensors C6, 7,8 5 5 0 0 0 0 C8. Finger Flexors C7, 8,T1 0 0. Finger Extensors C7,8 0 0 0 0 T1. Hand Intrinsic C8,T1 0 0 0 0 T2. Thumb Flexors C7,8,T1 0 0 0 0 T3. Thumb Extensors C7,8 0 0 0 0 T4. ABD. DIG. MIN C8,T1 0 0 0 0 0 0 T5. Abdominal Muscles: Upper 0 0 0 0 T6. Lower 0 0 0 0 T7. ASIA Chart Lower Limb Time Motor Touch Pain MOTOR R L R L R L. Hip Flexors L2, 3 0 0 0 0 0 0 T8. Extensors L5,S1,2 0 0 0 0 T9. Abduct. L4,5,S1 0 0 0 0 T10. Adduct. L3,4 0 0 0 0 T11. Knee Flexors L4,5,S1,2 0 0 0 0 T12. Knee Extensors L2, 3,4 0 0. Ankle DF L4, 5,S1 0 0 0 0 0 0 L1. PF S1,2 0 0 0 0 0 0 L2. Toe Flexors L5, S1,2 0 0 0 0 L3. Extensors L4,5,S1 0 0 0 0 0 0 L4. 0 0 0 0 L5. REFLEXES. 0 0 0 0 S1. ASIA SCORE 0 0 0 0 S2. Total ASIA score 26 /100 0 0 0 0 S3. 0 0 0 0 S4-5. ASIA Chart Upper Limb and Trunk Date Time Motor Touch Pain MOTOR R L R L R L. Shoulder Elevators C3, 4 2 2 2 2 C2.

4 Abductors C5, 6 2 2 2 2 C3. Adductors C5-T1 2 2 2 2 C4. Elbow Flexors C5,6 5 5 2 2 2 2 C5. Elbow Extensors C7, 8,T1 3 3 2 2 2 2 C6. Wrist Flexors C6,7,8 2 1 1 1 C7. Wrist Extensors C6, 7,8 5 5 0 0 0 0 C8. Finger Flexors C7, 8,T1 0 0. Finger Extensors C7,8 0 0 T1. Hand Intrinsic Thumb Flexors C8,T1. C7,8,T1. Thumb Extensors C7,8. Level ? 0. 0. 0. 0. 0. 0. T2. T3. T4. ABD. DIG. MIN C8,T1 0 0 0 0 0 0 T5. Abdominal Muscles: Upper 0 0 0 0 T6. Lower 0 0 0 0 T7. ASIA Chart Upper Limb and Trunk Date Time Motor Touch Pain MOTOR R L R L R L. Shoulder Elevators C3, 4 2 2 2 2 C2. Abductors C5, 6 2 2 2 2 C3. Adductors C5-T1 2 2 2 2 C4. Elbow Flexors C5,6 5 5 2 2 2 2 C5. Elbow Extensors C7, 8,T1 3 3 2 2 2 2 C6. Wrist Flexors C6,7,8 2 1 1 1 C7. Wrist Extensors C6, 7,8 5 5 0 0 0 0 C8. Finger Flexors C7, 8,T1 0 0. Finger Extensors C7,8 0 0 0 0 T1. Hand Intrinsic Thumb Flexors C8,T1. C7,8,T1. Thumb Extensors C7,8. C6 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. T2. T3.

5 T4. ABD. DIG. MIN C8,T1 0 0 0 0 0 0 T5. Abdominal Muscles: Upper 0 0 0 0 T6. Lower 0 0 0 0 T7. Level of Injury Sensory Level -the most caudal, intact dermatome for both pin prick and light touch sensation. Motor Level -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). neurological Level of Injury - the most cephalad of the sensory and motor levels Zone of Partial Preservation Only applies in Complete Injuries No sensation or motor Function in S4/S5. Levels below neurological Level with some motor or sensory Function ASIA Scale A Complete. No sensation or motor Function in S4/S5. B Incomplete. Sensation but no motor C Incomplete. Motor, > 50% < 3. D Incomplete. Motor, > 50% > 3. E Normal Neurological Level and clinical significance C3 or above- diaphragm palsy- ventilatory support Injury at T6 or above will interfere with blood pressure control- autonomic dysreflexia, orthostatic hypotension Above T10- reflexogenic penile erection Supraconal vs conal /infra conal Injury Level of Injury in paraplegia Spastic paraplegia Flaccid paraplegia Supraconal Injury At or below conus Injury Increase muscle tone Reduced muscle tone,(no (spasm), reflexes, spasm issue) , absent of Spastic bladder reflexes Reflexic bowel Flaccid /atonic bladder Reflexic erection Flaccid /atonic bowel No reflexic erection Functional outcome following SCI.

6 Level of Injury Completeness of Injury ( AIS ). Other Age, gender and body shape comorbidities Motivation Values, roles and lifestyle Environment Spinal Cord Injury C1,C2,C3. Ventilated Neck Movement, Shoulder shrug Power chair sip / puff Eye Gaze C4 ASIA -A. C4. Breathes Neck Movement, Shoulder shrug Power chair sip / puff or chin control Normal communication Assistive technology Hoist transfer C5 ASIA-A. C6 ASIA A. C7 ASIA A. C8/T1 ASIA A. Paraplegia ASIA A. Manual chair Self caring Independent transfer Normal activities Driving adapted car T10. Ambulation according to ASIA Grade ASIA GRADE BASELINE EXAM RATE OF AMBULATION. at discharge ASIA -A <72 hrs 0% ambulate ASIA -B <72 hrs 48% household ambulation ASIA -C <72 hrs <50 yrs 91% household ambulation >50 yrs 42%household ambulation ASIA -D <72hrs >95% community ambulate Determine the potential functional outcomes Formulate functional goals during inpatient rehabilitation programme. THANK YOU.