ASIA impairment scale for spinal injury
Updates to Article Attributes
Body
was changed:
The American Spinal Injury Association (ASIAImpairment Scale) was was developed by the American Spinal Injury Association (ASIA) in 2006, was revised in 2011, and at the time of writing (July 2016), remains the most widely used scale.
This scale is partneurologic classification of the ASIA spinal cord injury classification. It.
Classification
The scale divides spinal cord injuries into 5 categories, with optional clinical syndromes:
-
A: complete
- no sensory or motor function at the most caudal sacral segments (S4-S5) as measured by perianal light touch or pinprick sensation, deep anal pressure sensation, and voluntary anal sphincter contraction
-
B: incomplete sensory
- sensory but not motor function is preserved below the neurological level
and includesincluding sensory sacral sparing, AND no motor function is preserved more than three levels below thesacral segments S4-S5motor level on either side of the body
- sensory but not motor function is preserved below the neurological level
-
C: incomplete motor
- 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 strength
-
D: incomplete motor
- 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 strength
-
E: normal
- prior injury now with normal motor and sensory testing
The neurological level of injury is the lowest (most caudal) segment above which there is preserved sensation and at least antigravity (grade 3) motor function on both sides of the body. The motor and sensory levels are specified separately for each side and can either be at or below (more caudal) than the single overall neurological level. The motor level is the lowest of ten key myotomes (C5-T1 and L2-S1) that has at least grade 3 (antigravity) function and above which there is grade 5 (normal) function. The sensory level is the lowest of 28 dermatomes (C2 to S4-5) that is intact to both pinprick and light touch sensation.
Optional clinicalClinical syndromes
Incomplete spinal cord injuries can optionally be differentiated by syndrome:
- central cord syndrome
- Brown-Sequard syndrome
- anterior cord syndrome
- conus medullaris
compressionsyndrome - cauda equina
compressionsyndrome
Muscle strength grading
- 0: total paralysis
- 1: palpable or visible contraction
- 2: active movement, full range of motion, gravity eliminated
- 3: active movement, full range of motion, against gravity
- 4: active movement, full range of motion, against gravity and provides some resistance
- 5: active movement, full range of motion, against gravity and provides normal resistance
- 5*: muscle able to exert, in examiner’s judgement, sufficient resistance to be considered normal if identifiable inhibiting factors were not present
-<p>The <strong>American Spinal Injury Association</strong> (<strong>ASIA</strong>) was developed by the American Spinal Injury Association in 2006, and at the time of writing (July 2016), remains the most widely used scale.</p><p>This scale is part of the ASIA spinal cord injury classification. It divides spinal cord injuries into 5 categories, with optional clinical syndromes:</p><ul>- +<p>The <strong>American Spinal Injury Association</strong> <strong>Impairment Scale</strong> was developed by the American Spinal Injury Association (ASIA) in 2006, was revised in 2011, and remains the most widely used neurologic classification of <a href="/articles/spinal-cord-injury">spinal cord injury</a>.</p><h4>Classification</h4><p>The scale divides spinal cord injuries into 5 categories:</p><ul>
-<strong>A: </strong>complete</li>- +<strong>A: </strong>complete<ul><li>no sensory or motor function at the most caudal sacral segments (S4-S5) as measured by perianal light touch or pinprick sensation, deep anal pressure sensation, and voluntary anal sphincter contraction</li></ul>
- +</li>
-<strong>B: </strong>incomplete<ul><li>sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-S5</li></ul>- +<strong>B: </strong>incomplete sensory<ul><li>sensory but not motor function is preserved below the neurological level including sensory sacral sparing, AND no motor function is preserved more than three levels below the motor level on either side of the body</li></ul>
-<strong>C: </strong>incomplete<ul><li>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 strength</li></ul>- +<strong>C: </strong>incomplete motor<ul><li>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 strength</li></ul>
-<strong>D: </strong>incomplete<ul><li>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 strength</li></ul>- +<strong>D: </strong>incomplete motor<ul><li>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 strength</li></ul>
-<strong>E: </strong>normal</li>-</ul><h4>Optional clinical syndromes</h4><ul>- +<strong>E: </strong>normal<ul><li>prior injury now with normal motor and sensory testing</li></ul>
- +</li>
- +</ul><p>The neurological level of injury is the lowest (most caudal) segment above which there is preserved sensation and at least antigravity (grade 3) motor function on both sides of the body. The motor and sensory levels are specified separately for each side and can either be at or below (more caudal) than the single overall neurological level. The motor level is the lowest of ten key myotomes (C5-T1 and L2-S1) that has at least grade 3 (antigravity) function and above which there is grade 5 (normal) function. The sensory level is the lowest of 28 dermatomes (C2 to S4-5) that is intact to both pinprick and light touch sensation.</p><h4>Clinical syndromes</h4><p>Incomplete spinal cord injuries can optionally be differentiated by syndrome:</p><ul>
-<li><a href="/articles/anterior-cord-syndrome">anterior cord syndrome</a></li>-<li><a href="/articles/conus-medullaris-compression-syndrome">conus medullaris compression syndrome</a></li>-<li><a href="/articles/cauda-equina-compression-syndrome">cauda equina compression syndrome</a></li>- +<li><a href="/articles/ventral-cord-syndrome">anterior cord syndrome</a></li>
- +<li><a href="/articles/conus-medullaris-syndrome">conus medullaris syndrome</a></li>
- +<li><a href="/articles/cauda-equina-syndrome">cauda equina syndrome</a></li>
References changed:
- Kirshblum SC, Burns SP, Biering-Sorensen F, Donovan W, Graves DE, Jha A, Johansen M, Jones L, Krassioukov A, Mulcahey MJ, Schmidt-Read M, Waring W. International standards for neurological classification of spinal cord injury (revised 2011). (2011) The journal of spinal cord medicine. 34 (6): 535-46. <a href="https://doi.org/10.1179/204577211X13207446293695">doi:10.1179/204577211X13207446293695</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/22330108">Pubmed</a> <span class="ref_v4"></span>
- <a href="http://www.asia-spinalinjury.org/publications/2006_Classif_worksheet.pdf"> Work sheet available here </a>
- www.asia-spinalinjury.org
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