Sci

Front 1

hx

Back 1

How and when injury occurred. Accident, were other things injured? Type of injury.

Front 2

SC level and V level

Back 2

SC ends L1-L2 V level- not full length. SC damaged level does not = vertebral level. Rostral- head. Caudal- tail. More caudal; more descent of n w/in canal to reach exit point. damage at one level can impact n roots coming down from higher levels. Damage to SC = CNS/UMN patho. Damage to spinal nerve = PNS/LMN patho. N roots. Mixed- both. more caudally spinal nn must descend w/in canal before exiting.

Front 3

ASIA ISCOS classification

Back 3

= Standardized test used to classify SCI level in pts from acute through rehab. help determine prognosis. Initially, frequently to track changes– looking for emerging incompleteness or growing ZPP. Rate of recovery helpful. Can change level over time w/ return and strengthening. Always in supine. Perform entire assessment

Front 4

motor level of injury

Back 4

most caudal key muscle with at least a 3/5 MMT and all rostral key muscles have a 5/5 MMT = last intact motor level. Right and left.

Front 5

sensory level of injury

Back 5

most caudal level intact to both pin prick and light touch (scored a 2). Right and left.

Front 6

single neurological level of injury

Back 6

Most caudal level where bilateral motor and sensory are intact (where all 4 are intact).

Front 7

ASIA key mm by level

Back 7

C5- e flex. C6- w ext. C7- e ext. C8= finger flex (DIP of 3rd). T1- finger abd (5th). T2-L1 no key mm; use sensory level to determine motor level. L2- hip flexors. L3- knee ext. L4- DF. L5- big toe ext. S1- PF. Specific sensory areas

Front 8

complete

Back 8

absent sensory and motor function at the S4 & S5 segments (lowest sacral).

Front 9

incomplete

Back 9

some remaining sensory and/or motor function at the lowest sacral segments.

Front 10

ASIA A

Back 10

Complete: no sensory or motor function is spared in S4-S5.

Front 11

ASIA B

Back 11

Incomplete: sensory function is preserved below the neurological level and is present in S4-S5 (absent motor in lowest segment). Sensory no motor.

Front 12

ASIA C

Back 12

Incomplete: motor function is preserved below the neurological level & more than ½ of the key muscles below the neurological level are < 3/5 strength. Motor present. Mm test the mm below the injury level.

Front 13

ASIA D

Back 13

Incomplete: motor function is preserved below the neurological level & more than ½ of the key muscles are > 3/5 strength. Motor present.

Front 14

ASIA E

Back 14

Normal: motor and sensory function are normal.

Front 15

specific incomplete syndromes

Back 15

own categories; not A/B/C/D/E... Brown-Sequard. Central cord. Ant cord. Conus medullaris. Cauda equina.

Front 16

brown-sequard

Back 16

Hemisection of the cord. Motor tracts on same side; weakness on same side as the lesion. Dorsal column cross at BS- light touch, 2 point impaired ipsi. Spinothalamic- cross right away; pain/temp impairments in contra limb.

Front 17

central cord

Back 17

Usually caused by mechanism of injury that results in swelling in SC; central portion of SC impacted. UE > LE. B/c C level- most median of tracts are for UE; most lateral are for the LE. Motor and sensory.

Front 18

ant cord

Back 18

Infarct. Dorsal column intact. Bilat involvement below level for ant/lat pain and motor tracts.

Front 19

conus medullaris

Back 19

UMN and LMN lesion. Last bit of SC.

Front 20

cauda equina

Back 20

LMN lesion.

Front 21

ASIA sensory testing

Back 21

Dermatomes-information needed for ASIA classification and to establish baseline. Light touch, 2-point discrimination: dorsal column. Sharp/dull, pin prick, protective: spinothalamic tract. ASIA chart identifies specific point that is innervated by only one spinal nerve . Specific points can be located by boney landmarks.

Front 22

extra sensory testing (outside ASIA)

Back 22

Functionally significant sensory info. Kinesthesia/proprioception/vibration - dorsal column. While not part of ASIA, we will still want to know.

Front 23

ASIA sensory testing protocol

Back 23

Use area of known intact sensation (on the face) for reference comparison. Do not use opposite side of body as a reference. Can you feel this? Same or diff? Light touch: 1cm light brush with wisp of cotton. Pinprick: sharp and dull side of safety pin used. Prevent substitution with other senses, eg vision.

Front 24

ASIA sensory scoring

Back 24

2 = normal = same as felt on face. 1 = impaired = can sense, but feels different than face. 0 = absent. If you do sharp; but they say dull- also a 0. Can't differentiate. Personal preference to do sharp in each dermatome b/c of this.

Front 25

ASIA mm testing

Back 25

Comprehensive testing of all available muscles. Beware of muscle substitution. Provide proximal stability. In supine, the bed is providing this. ASIA key muscle testing. 0-5 scale. Important to avoid mm substitution by proper positioning and stabilization. It is important to test all muscles (not just key) as there are other functionally important muscles.

Front 26

what does key mm mean?

Back 26

The addition of that muscle has a functional significance. C5- elbow flex- self care. C6- wrist ext- tenodesis grip. C7- elbow ext- transfers, P relief. C8- finger flex- grasp. T1- full hand function. L2- hip flex- advancing. L3- knee ext- transfers.

Front 27

ASIA v myotome

why?

Back 27

C4 - / shoulder shrug

C5 elbow flex / GH abd

C6 wrsit ext / elbow flex/wrist ext

C7 elbow ext / elbow ext/wrist flex

C8 finger flex / UD, thumb ext

T1 finger abd / finger abd/add

Intact = 3/5 MMT; can get w/ only C5 for elbow flexors. Why they don't need C5 & 6 to have elbow flex level.

Front 28

common UE mm subs

Back 28

Wrist ext (C6) Forearm sup and gravity.

Elbow ext (C7) Ant deltoid with distal end fixed- can pull humerus forward.; don't assume triceps there if you saw them push up or propel w/c. GH ER with distal end free (hold condyles strongly; becomes gravity assisted).

Third Finger flex (C8) Wrist ext for finger flexion- tenodesis.

Fifth Finger abd (T1) Finger extension.

Front 29

common LE mm subs

Back 29

Ankle dorsiflexion (L4) Great to extension (EHL)

Long toe extension (L5) Ankle plantarflexion – tenodesis of the foot. Active great toe flexion and then release, rebound into toe ext.

Ankle plantarflexion (S1) Hip flexion to facilitate PF (in grade 3 position)

Front 30

motor- trunk

Back 30

Pull of umbilicus. Symmetry? Only upper abs will put it up; one side can pull if stronger. Palpate for specific level. Functionally is plevis rotating posteriorly? Whatever is the intact sensory level is also intact motor for T2-L1. Stability of joints. Lift GH. Sit up.

Front 31

tone- UMN v LMN

Back 31

UMN involvement results in spasticity. Reflex loop remains intact- picture. Spasticity b/c no control.

LMN involvement results in flaccidity. Reflex loop is interrupted- picture.

Combinations.

Can help or get in the way

Front 32

Tone MAS

Back 32

Grade Description (response to passive stretch) 0 No increase in muscle tone. 1 Slight increase in muscle tone; catch-release or at end of motion. 1+ Slight increase in muscle tone; catch-resistance. 2 Marked increase in muscle tone through most of motion; easily moved. 3 Considerable increase in muscle tone; passive movement difficult. 4 Affected parts rigid in flexion or extension.

Front 33

prior hx to gather

Back 33

pre-injury function.

other injuries.

surgeries.

meds.

resp function.

Front 34

pre injury function- hx

Back 34

Social environment. Participation in life events. Job and free time activities. Living situation. Most likely younger- less settled and less resources. Less outside assistance. Role in family, school, work, community. Support system. D/C destination. Inpatient will not take unless there is a d/c plan.

Front 35

other injuries- hx

Back 35

(common with traumatic injury). Musculoskeletal. Internal injuries. Brain injury. We might the 1st to be taxing this and 1st to note this. Skin.

Front 36

surgeries- hx

Back 36

What was done/type of fixation. Precautions. Brace/orthosis required for out of bed? Don/doff position. .

Front 37

meds- hx

Back 37

Impacts on rehab.

Front 38

resp status- hx

Back 38

Diaphragm- C4; intercostals- segmental (may have partial or no inn). Resp compromise common. Knowing if other previous status imp b/c then higher risk of probs. Asthma. Smoker

Front 39

CP and CV system review

Back 39

Ventilator (at least C4 level for intact diaphragm). Trach scar. Chest tubes. Cardiac monitor. TLSO or other that may restrict breathing. Influence of position on respiratory status.*

Front 40

position and resp status

Back 40

Supine- diaphragm against gravity, lateral ribcage is gravity eliminated. A against gravity; P blocked. Sidelying- diaphragm is gravity eliminated. A/P excursion is GE. Prone- diaphragm blocked; if primary diaphragmatic breather they may feel panicked. Breaks.

Front 41

changes in CV system

Back 41

CN X intact- parasympathetic. Sympathetic control at T level- can be impacted. W/ C & high T level injuries, can lose supraspinal control over sympathetic nervous system (T1-L2) below level of injury; = reduced symp activity. Therefore, bradycardia, arrhythmias, & dilation of peripheral vasculature (hypotension-- general & orthostatic) can occur. HUGE probs; especially early. VITALS!! Impacts tolerance to vertical and EX. Less likely if below C6.

Front 42

integumentary system review

Back 42

Abrasions. IV sites. !!**Potential area for skin breakdown**!! Decreased ability to change positions. Decreased sensation. Education is a huge part- give knowledge and responsibility to be sure it is done. Supine every 2h. W/c P relief every 15 min.

Front 43

cognitive status system review

Back 43

communication, affect, cognition, language, and learning style. Rehabilitation requires a lot of learning; get to know learning style. Utilize motor learning principles. Very important. High rep. Chance to prob solve. Readiness to learn. Presence of TBI?

Front 44

TM- aerobic capacity/endurance/ventilation

Back 44

Vital signs: baseline, during, and after activity. Thoracoabdominal movements and breathing patterns with activity. Responses to positional changes. Need to understand what is working against gravity, what is gravity eliminated, what is gravity assisted, and what is blocked. Pulse oximetry. Full assessment will be covered later.

Front 45

TM- Anthropometric Characteristics-

Back 45

Height, weight, girth. Pre-morbid weight. Body type. Male vs female. Arm vs trunk length. Big role. Longer the arms relative to trunk unweighting and transfers are easier. Where weight is carried- sup easier; hips harder. Edema.

Front 46

ROM overall

Back 46

Complete examination of all ranges. Normal ROM may not always be the goal. Selective tightness.

Hyper-mobility. Getting in and out of long sitting. Very important for functional tasks

Front 47

ROM precautions

Back 47

Unstable L fx. No hip flex > 90º or SLR > 60º

Unstable C fx. No GH flex or abd > 90º.

Confounding factors for testing. Immobilization devices may limit full ROM. Pain. Proximal stability at GH.

Front 48

Implications of ROM on function.

Back 48

Extremes in range play an important role in compensating for decreased strength. Loss of motion can limit function (eg elbow extension). Can limit IND!

Front 49

contractures

Back 49

PREVENT common contractures in UE of pt w/ tetraplegia: (arms across chest; night splint) GH often in flex, add, and IR- shortened. Prolonged positioning in elbow flex- especially when no triceps function- = contractures. Forearm pro positioning- especially w/ no sup mm function- results in pro contractures. Common LE: Hip flexor. Ankle PF. Multi-podus boots.

Front 50

C ROM

Back 50

Goals. Normal ROM w/in limits of any fixation. Avoid tightness in forward head posture.

Functional sig- Forward head posture can interfere w/ balance (head mov'ts used for adjusting COM in sitting) and compromise resp.

Front 51

trunk ROM goals

Back 51

Mild tightness in the low back is desired. Stability (not stuck in post tilt), ability to lift to P relief. Avoid overstretching of back extensors. In long sitting if do not have 90/100 SLR hamstring length. Avoid long-sitting with tight hamstrings.

Front 52

trunk ROM functional sig

Back 52

Passive trunk stability in sitting. Creates tighter connection between lower trunk and upper trunk which makes transfers and rolling more efficient. Question: when would these goals be important? If no abs, P relief lift, the bottom may not clear b/c no abs to help lift- get tightness in L back ext the pelvis will come a little easier.

Front 53

hip/hamstring ROM

Back 53

Goals At least 100° hip flexion, 45° of external rotation, 10° hip extension. SLR of 110°.

Functional Significance- Dressing, bed mobility, long sitting balance, transfers and ambulation. Question: when would these goals be important? Prone, dressing. If too much then flop forward in long sitting. Start day 1. Long sitting more stable

Front 54

ankle ROM

Back 54

Goals Dorsiflexion 5°-10°.

Functional Significance Allows for proper foot position on foot plates and during transfers. Required for ambulation. Question: when would this goal be important? Foot plate, transfers, amb.

Front 55

GH ROM goals

Back 55

Full scapulothoracic and glenohumeral motions including 90° – 100° of extension and 90° of external and internal rotation. Less motion with unstable shoulder (C4 +).

Front 56

GH ROM functional sig

Back 56

Shoulder hyperextension for certain bed mobility skills and to hook push handle when sitting in wheelchair. Rotation allows elbows to biomechanically lock into extension in weight bearing. Question: when would these goals be important? Day 1 stretching- flex, abd, ext! Only w/ stable GH/scapula- intact C5; SITS, deltoid.

Front 57

elbow ROM

Back 57

Goals Maintain full motion, especially extension, supination and pronation.

Functional sig- Allows elbow to biomechanically lock in extension in weight bearing. Feeding and grooming. Question: when would these goals be important? Need full ROM if no triceps for bed mobility and transfers. Contractures will limit level of IND. Pro- feeding.

Front 58

wrist ROM

Back 58

Goal Attain 90° of wrist extension.

Functional significance Allows for UE WB. Maximizes tenodesis action. Question: at which levels of injury would these goals be important? Tighter grasp.

Front 59

fingers/thumb ROM goals

Back 59

Mild tightness in long finger flexors. Prevent overstretching of thumb’s web space. Adequate web space for using thumb as a hook.

Front 60

finger/thumb ROM functional sig

Back 60

Development of functional tenodesis. Achieve grasp with thumb and first two fingers. Question: when would these goals be important? No wrist and finger ext together. C6/7 need tenodesis. C8 has grasp.

Front 61

pain types

Back 61

Nocioceptive. Musculoskeletal. Above level of injury

Neurogenic Burning, stabbing, tingling. Sensed below level of injury. Less common in complete injuries.

Front 62

functional mob assessment

Back 62

Bed mobility. Rolling. Scooting. Supine. Sit.

Transfers. Even surfaces. Uneven surfaces. Sit --> Stand

Front 63

posture assessment

Back 63

Resting posture-all positions. Static and dynamic posture. Influence on breathing.

Front 64

gait/locomation and balance assessment

Back 64

Wheelchair. Even, uneven surfaces. Curbs/steps. Doorways. Balance in sitting, standing, transitions. Static. Dynamic. Equilibrium and righting reactions. TLSO. Gait.

Front 65

environmental barriers

Back 65

Physical Space. Room for w/c to maneuver. Doorway width at entrance and all rooms. Current and potential barriers. Stairs. Floor surface. Counter height/room for approach. Other

Front 66

phonation

Back 66

Eccentric control of the diaphragm. Control force and duration. 8-10 syllables per breath is normal; they may need more breathes. SLP.

Role of PT- Awareness of breathing. Strengthening of mm. Positioning changes and breathing.

observe- Length. Voice intensity. Voice quality.

Front 67

cough

Back 67

Necessary for mov't of secretions.

Four stages: Adequate inhalation. Closure of glottis. Build up of P. (Abdominals; intercostals. Contract. Abs- T7 to 12 ish.) Expulsion. Consider coordination and mm requirements.

Role of PT- cough techniques. At risk for aspiration, choking, poor pulmonary health. Observe- (as if you have something in your throat) Adequate inspiration. Timing. Force. Effectiveness.

Front 68

deep insp

Back 68

Maintain bronchial hygiene. Chest expansion in all three planes. Aerate all portions of the lung. Full innervation of diaphragm and intercostal muscles. If just d then no expansion in all 3 planes.

Front 69

position of diaphragm

Back 69

What happens when abdominal mm are not innervated? In sitting: diaphragm lowers 2º drop in abdominal contents position. This results in shortened resting position and a less effective contraction. Stomach pooch. Decreased excursion and less effective. Gravity’s role in diaphragm function. With intact CNS neural input to diaphragm increases w/ upright posture. Abdominal binder can help.

Front 70

rib observation

Back 70

[Not acute, happen over time] Flattened anterior chest wall. Supine more. Cavus deformity. Flaring of lower ribs. Triangle vs. square. Triangle- less pecs. Neg P of diaphragm pulls the ribs in. W/ pecs able to maintain some of the shape and resist the change in shape.

Front 71

tone observation

Back 71

Posture: scapula/UE and pelvic position relative to trunk. Posture: Spine. Kyphosis. Lordosis. Scoliosis.

Front 72

breathing observation

Back 72

Paradoxical. No inn intercostals. Belly up and ribs down. (top)

Accessory mm. (bottom pic). Any mm that attaches to ribcage. Prop on arms- reverse motion of mm. Pecs, scap mm. SCM, upper trap.

Lateral. Shallow. Asymmetrical.

Front 73

resp tests and measures

Back 73

Vital signs. Vital capacity. Tidal volume. FEV1. Chest Expansion. Auscultation. ROM. Strength.

Front 74

resp observe

Back 74

ribs. tone, breathing pattern. phonation, cough.

Front 75

heterotrophic ossification

Back 75

Ectopic bone formation, bone formed in mm and other CT, usually in hips/knees and elbow. Risk factors: complete lesions, male gender, age, spasticity. Below level of lesion. ROM, warmth, swelling. Time to let Dr. know.

Front 76

autonomic dysreflexia

Back 76

Occurs with lesions >T6 level. Caused by perceived noxious stimulation below level of lesion; #1 bladder infections. Pain, tone, UTI, fx, sexual response, labor. Response: headache (from high BP), increased BP (can be life threatening), bradycardia, diaphoresis, goosebumps, flushing.

Front 77

autonomic dysreflexia noxious stim response

Back 77

The noxious stimulus triggers an exaggerated sympathetic response 2º lack of descending inhibition. This results in increased cardiac output and peripheral vasoconstriction, high BP. This stimulates baroreceptors in aortic arch and carotid sinus, parasympathetic response which slows the heart. Treatment: Remove noxious stimulation. This is emergent.

Front 78

C orthosis

Back 78

HALO- screw into skull. Highest level of C immobility. Used when they cannot do surgery.

SOMI- sternal occipital mandibular immobilizer. Decent.

Less effective- Philadelphia Collar- harder plastic neck immobilizer. Soft collar - can move against it; reminder.

Front 79

TLSO

Back 79

thoracolumbar sacral orthosis Molded body jacket. Pt specific. Upright or out of bed. We are usually the 1st to put on and sit them up. Don/doff in lab. Limits rib and abdominal excursion. Challenge if diaphragmatic breather- can cut out window to allow more excursion. Hyperextension. Jewett.

Front 80

KAFO

RGO

Back 80

locked out in ext, ankles in DF. Crutches or lofstrand crutches for amb.

reciprocating gait orthoses- crosses hip joint. May or may not lock out; usually does not. Tension in cables designed to bring limb forward when it is unweighted. Hard/high energy to don/doff. Skin breakdown?

Front 81

detrusor

Back 81

(smooth mm.) Stretch reflex. Parasympathetic (S2-4) innervation involved in detrusor contraction. Facilitates stretch reflex. Sympathetic (T11-L2) innervation responsible for relaxation of the detrusor. Cognitively override stretch reflex.

Front 82

urethral sphincter and periurethral pelvic floor

Back 82

Somatic innervation (sacral 2-4) with both reflex and voluntary control. Not a smooth mm.

While bladder emptying is a reflex action, there is voluntary control (descending input from CC) that can facilitate the reflex and inhibit the external sphincter and pelvic floor muscles.

Front 83

SCI and bladder control

Back 83

Withcomplete SCI, whether or not the sacral reflexarc is intact determines how the bladder will function.

Front 84

bladder and C/T lebel

Back 84

reflexively functioning bladder and no CC input. Initially during spinal shock, bladder flaccid and pt will have indwelling catheter. When bladder begins to fill, will stim reflex arc and result in contraction of detrusor. Loss of voluntary relaxation. bladder will reflexively empty when full but you cannot always count on timing or full emptying. Intermittent cath. External catheter (men). Neurogenic bladder.

Front 85

bladder and L/S

Back 85

Lumbar level injuries may result in less effective bladder emptying.

Sacral level and cauda equina injury results in a-reflexive bladder/flaccid bladder. Without sacral reflex arc, the detrusor muscle is flaccid (no parasympathetic input). At risk for urinary retention. Either intermittent catheterization or more permanent indwelling catheter.

Front 86

bowel

Back 86

Voluntary control of anal sphincter. Internal sphincter- reflexively controlled (parasympathetic sacral 2-4).w/o sacral reflex (a-reflexive bowel) bowel will not empty reflexively; at risk for impaction and/or incontinence (b/c of lack of external sphincter control).w/ reflexive emptying, still at risk for incontinence because of lack of external sphincter control. Can stim this.

Front 87

bowel programs

Back 87

Designed to train the body to evacuate the bowels at the same time every day or every other day. Role of PT Bowel program takes priority over PT. Tolerance to upright positions for easier bowel management. Physical activity promotes motility. If using commode, make sure skin integrity not compromised.

Front 88

sexual female and male

Back 88

Fertile. Genital functioning not altered as much as with males. More social difficulties however.

Can father children with intervention. Impaired genital functioning.

Front 89

PLISSIT model

Back 89

sexual function. Permission; limited information; specific suggestions; intensive therapy. We function in the first 2.

Front 90

tolerance to vertical

Back 90

large focus initially. Out of bed options. Strategies to lessen postural hypotension: Compression stockings. ACE wraps (usually step 1). Abdominal binder. Reclining or tilt in space w/c. Hoyer lift into Tilt table. Standing Frame. BP values. Symptom driven. They may run low (eg 70/50) and still have no symptoms.

Front 91

joint protection

Back 91

GH Pain- Overuse/rep mov't injuries. Increased WB demands. Increased ROM demands.

Hip position-ER and Abd, most stable structurally, prevents post dislocation. Be careful not to overstretch post structures of hip joint during hamstring stretching.

Front 92

posture and joint protection

Back 92

Posture/alignment is #1 line of offence and defense. More upright is better for GH. Need to take IND and risk into account- GH injury can limit IND. SITS and scap mm EX for life.

Front 93

OP

Back 93

Will have OP in 10-20y. Not getting the mm contraction around the bones. Add to contraindications. No aggressive stretching.

Front 94

mm substitutions

Back 94

agonist mm. gravity. tension. distal end fixed. momentum. head-hips relationship

Front 95

agonist mm

Back 95

Substitution using other available agonist muscles. Not always available after SCI unless incomplete.

Front 96

gravity sub

Back 96

Position body part so gravity will effect desired motion.

Sitting GH abd/IR to pronate.

Rolling- UE momentum (arms <90 flex)

GH ER to next elbow

Swing to gait- gravity advances

Front 97

tension sub

momentum sub

Back 97

in passive structures. Rotation of trunk by using Lats (tight) to assist in role. Tenodesis grasp. Flex wrist, fingers ext. Ext wrist, fingers flex

Swinging arms/head in order to roll. 1 arm hooked, head and arm forward and to side to scoot.

Front 98

distal end fixed sub

Back 98

With distal end fixed, the proximal mm causes mov't at intermediate joint.

W/ hand fixed WB and elbow flexed, GH flexion and ER will lock elbow in ext.

propel w/c w/ ant delt/flex

Front 99

head hips relationship

Back 99

First class lever-UE’s usually the fulcrum (needs a fulcrum to work). Fulcrum usually the arms. Head down, bottom up. Head to right, bottom to left. Use head mov't to direct pelvis.

Front 100

ASIA steps

Back 100

1. Sensory level (R/L)

2. Motor level (R/L)

3. Single neurological level

4. Determine completeness- sacral sparing. complete injuries only- (ZPP).

5. ASIA impairment scale AIS

Front 101

sensory info

Back 101

Key sensory points. Representative of dermatomal area found in majority of body mapping. Found via palpation of boney landmarks for reliability. T3 close to C4- most likely to confuse. Test methodically. In order

Front 102

light touvh

Back 102

Wisp of cotton swiped ONCE over 1cm on face to use as a normal comparison- can swipe face again if pt needs reminder throughout test. Immediate response is used as result. Sensation may travel throughdiff pathway and that delayed response it not accurate for spinal segment being tested. If swipe needs to be repeated allow enough time to lapse so that false + of accumulated sensation does not occur.

Front 103

light touch grade

Back 103

0- not felt

1- felt but differs from normal comparison.

2- felt and same as normal comparison.

NT- Pt report is not reliable, pt cannot follow instructions or key point or alt point* not available. * Can use alt single point in dermatome if key point is unavailable- note for re test

Front 104

pin prick

Back 104

Open safety pin used, pointed end (sharp), rounded cap end (dull)- offer both on face as example of normal.Alt sharp/dull on key sensory points in an “irregular non-predictable manner”. Need every dermatome tested w/ both. If you question reliability of pt report, you can test the segment w/ 10 reps (spaced out) and 8/10 correct considered accurate/intact.

Front 105

pin prick grading

Back 105

0- Absent or cannot discriminate b/n sharp and dull.

1- Impaired- can distinguish b/n but reports sharp is diff than “normal” comparison.

2- Normal- distinguish b/n sharp/dull, and same as “normal” comparison.

Front 106

deep anal sensation

Back 106

Deep Anal sensation- if LT and PP are absent in S3-5. Digital exam of rectal wall.

Front 107

key mm

Back 107

One muscle action needed per spinal segment. Action had to have functional significance. Accessible and isolated in supine position. If innervation is primarily from 2 spinal levels-most rostral level chosen. Axial muscles not chosen. Cannot be tested per international standards.

Front 108

Motor exam

Back 108

Done in supine. consistent position through rehab. Takes into account the effects of position on tone. Improves reliability for serial testing. 0-5 MMT scale no + or -. the most caudal key muscle w/ at least 3/5 strength AND all rostral keymm have 5/5 strength.

Front 109

motor special circumstances

Back 109

NT- unable to reliably test key muscle. Casted. Contraindication to active movement. Amputation.

5* Key muscle presumed to be normally innervated. “non neurogenic weakness”. Weakness secondary to pain or non-use.

Front 110

motor test guidelines

Back 110

Perform test in the same order each time to ensure reliability. Be accurate w/ placement of your stabilizing and resisting hands. Accurate instructions- especially when testing for 4 or 5/5. Assure maximal effort by patient. Reassure pt that you will stop testing if there is pain. Move though available PROM first. Start w/ 3/5 position and move up/down accordingly.

Front 111

PROM first

Back 111

motor testing. If > 50% normal PROM, then can test using 0-5 scale. If <50% normal PROM, then muscle is NT. If spasticity is present, try to relax pt and mm and try again. If you can’t get segment into position, then mm is NT. If you believe the mm is fully innervated but pain or disuse are the contributing factors for weakness found, score 5*

Front 112

motor scoring w/ sensory score

Back 112

if no key mm designated for a myotome, then intact/absent motor level is determined based on sensory level for that side. (2=intact motor). For C5/L1 motor levels are intact, you must also look to sensory testing results in rostral levels. These are used to determine if the “all rostral levels are 5/5” component of the rules for determining motor levels is met. Last place there was a 2.

Front 113

neurlogical level of injury

Back 113

most caudal segment ofcord w/ intact sensation and antigravity (3 or more) mm function strength, w/ normal (intact) sensory/motor function rostrally. Used as the reference point when determining between AIS C or D (count key mm below this level). mainly used for ease of in classifying subjects in research, not clinically specific to determine functional outcomes.

Front 114

zone of partial completion

Back 114

complete injuries only. Record R/L motor and R/L sensory. Lowest level below each motor and sensory level that has at least partial innervation. If none, ZPP is the ASIA level designated. Prognostic value. For ex: the larger (at least 3 levels) the sensory ZPP the more likely pt will convert from complete to motor incomplete by end of rehab. Same level w/ diff size ZPP have diff prognosis.

Front 115

B --> C scenario

Back 115

When lowest sacral segment has sensory but not motor (typically classified as B) AND has presence of voluntary motor function > 3 levels below L or R motor level, they are classified a C. Does not need to be key mm , (any voluntary mm contraction) and can be as min as 1/5. For prognostic reasons; greater likelihood of regaining more function.