Another Poll regarding Incomplete vs. Complete Injuries

[Curt Leatherbee]

This Poll asks whether you are a Complete Injury or an Incomplete Injury and if incomplete what kind of function and/or sensation do you have?

[gpbullock]

Does anyone here know or understand fully the labels "complete/incomplete?" I am a t12 "complete" by asia scale standards in that I don't have bladder or bowel control. However, when I was in the hospital, the neurosurgeon who did my decompression surgery called my condition "incomplete" because I could feel (partially)to my thighs and had slight flexion of part of my left quad muscle. It's been over a year and I still can't really say what I am.

[Shaun]

They told me i was complete but if im sittin on my balls i can feel it,i can feel my legs,ass,feet and sometimes make qaudriceps contract..WHAT AM I?
........\/PEACE
~Shaun~

[Scorpion]

I believe there is 'motor complete/incomplete' and 'sensory complete/incomplete.'

I'm a C-6 sensory incomplete as my sensation is normal to T-4 and light touch everywhere below. i can feel temperature and pain below T-4, but it's very diminished, so a hot pizza on my lap would just feel warm unless it sat there for a few seconds. I seem to have more sensation in the butt & groin.

~Rus

[Curt Leatherbee]

Lots of Incompletes. I am sure if I had done this survey 10 or 20 years ago I would be coming up with more completes than Incompletes, but since most people here were injured within the last ten years, new technology is helping people from losing everything from the injury site down (that is the case with me, I was injured 20 years ago) This was before the advent of Methylprednisone and decompression surgury was far less frequent than it is today. Interesting.

[SCI-Nurse]

Here are the ASIA (American Spinal Injury Association) criteria for different categories of completeness (partially paraphrased). These are international standards:

ASIA A: no sensation or movement below the level of injury. (this is called complete also)

ASIA B: some sparing of sensation (but no motor) below the level of injury, and this sensation MUST include the sacral dematomes (area around the genitals and anus).

ASIA C: some sparing of movement below the level of injury, but in the key muscles (there are 10 of these total) the majority of the muscles have a strength grade of less than 3 (out of 5).

ASIA D: sparing of some movement below the level of injury which must result in the majority of the key muscles having a strength grade of 3 or better (out of 5).

ASIA E: (rare) complete return of sensation and movement. May still have some abnormal deep tendon reflexes.

Under this system, if you have some sensation below your injury, but it does not include the area around your anus or genitals you would still be considered complete. It is an arbitrary, but consistently used system for quantifying how complete the injury is.

Of course as discussed before, it may take weeks or months (even years) to determine if the injury is truely complete or incomplete.

It is very difficult if not impossible to say that an injury is definately complete as soon as the person is injured or even during the time of the acute rehabilitation. The longer the person goes without any return, the more likely it is that the injury is complete.

Another major factor in the significant increase in incomplete injuries is improved on-the-scene EMS (emergency medical system) care. When untrained ambulance drivers (instead of paramedics) were picking people up off the hwy., there were many more people who were intact or incomplete at the scene only to arrive at the ER with a complete SCI because they were moved wrong. This is still very common in 3rd world countries...we see it in our patients injured in Mexico often. (KLD)

[Scorpion]

Thanks for the ASIA definitions, KLD. I guess I'm an ASIA B then, because I doubt wiggling a big toe or an occasional voluntary finger twitch make much difference. Maybe we should set this poll up again with these classifications?

~Rus

[Wise Young]

So far, this poll follows some of the trends that already have been established from acute spinal cord injury statistics. Over the past decade, about 64% of people who have had spinal cord injury in the U.S. have had incomplete spinal cord injury with varying degrees of recovery. This is a sharp reversal from the situation in the 1980's and 1970's where about 60% of the people had so-called "complete" spinal cord injury.

I decided to feature this poll to see if we can get more responses from the people who come to this site.

[Carl R]

I have always been told in complete C5. What exactly define sparring in or around the genitals and rectum? I can't actually feel touch to the area, but I know someone is touching me in that area because my pressure changes in my head. Is that considered incomplete?

[rybread]

There was an earlier poll on expected recovery from 1st generation cures that I feel had a lot to be desired. Expectations between a quadriplegic and a paraplegic are far different. In my short time as being a quadriplegic, I would give anything just to get my fingers and arms working to their full ability. I posted a poll asking the difference but no 1 replied. My doctor says that I am a C-5 complete injury, yet I have decent tenodesis on the right side. I also have feeling in my index finger and I can feel when my fingers are stretched out, but not by the skin. I have also proves to an occupational therapist in the past that I could get some muscles in my back and sides to work. I'm not sure if that was ever documented but it was noticeable. So Dr. Young, and my an incomplete or complete injury?

[Wise Young]

We faced exactly these questions when the American Spinal Injury Association (ASIA) Committee developed the international classficiation that is now accepted world-wide. A person may come in with "complete" spinal cord injury, i.e. no motor or sensory function below some level of the spinal cord, and then recover some function below that level over time. Is that person "complete" or "incomplete". For example, Christopher Reeve had no motor or sensory function below C2 for two years. Yet, now he can feel all the way down to his legs and this developed over a 2-3 year period. Is he complete or incomplete?

The ASIA committee decided to define "complete" spinal cord injury as the absence of motor and sensory function at the lowest level of the spinal cord (S5). This is the area around the anus. If there is no sensation or voluntary contraction of the anus, the person is defined as an ASIA A or a complete spinal cord injury. This means that a person can walk but still has "complete" spinal cord injury. It also means that if Christopher recovered his arms and hands, he would still have a "complete" spinal cord injury.

This definition is important because it recognizes the fact that the vast majority of patients (especially since methylprednisolone was discovered to have beneficial effects in spinal cord injury when given early) will recover to some degree from even the most severe spinal cord injury.

So, Carl, if you have any spinal level below which you have NO motor or sensory function, you are "complete" by the ASIA definition. If you really can consistently tell that somebody is touching you in the perineal region, it probably means that you are incomplete.

Rybread, you are recovering some function in your hand but you probably have a level below which you have no motor and sensory function. If so, you had and have a "complete" spinal cord injury.

Wise.

Wise

[etexley]

So when a trial asks for "complete" SCIs, they are looking for completeness by an ASIA definition rather than nothing below injury ??? Incidentally, that article said that Christopher can contract his phalanges now http://sci.rutgers.edu/forum/images/smilies/smile.gif

Eric Texley

[etexley]

So when a trial asks for "complete" SCIs, they are looking for completeness by an ASIA definition rather than nothing below injury ??? Incidentally, that article said that Christopher can contract his phalanges now http://sci.rutgers.edu/forum/images/smilies/smile.gif

Eric Texley

[PN]

Incomplete injury at C-2. Central cord syndrome.

PN

[Wise Young]

Eric, clinical trials do not necessary hew to the ASIA definition of complete versus incomplete. Many drug companies that fund clinical trials, for example, do not know the difference.

Also, there is the issue of when the condition is defined. A pers on who has no function below the injury site tends to have a lower probability of recovering substantially from the injury whereas a person who has function many segments below the injury and particularly in the lowest segment has a good prognosis of subs tantial recovery. However, as time passes and a patient who is initially "complete" but recovers some function many segments below the injury level does not have the same favorable prognosis. But, I must add that there are always exceptions.

Christopher Reeve was a so-called "complete" spinal cord injury with no motor or sensory function below the neck (C1/2) for months after spinal cord injury. However, he is now able to feel all the way to the sacrum and has some shoulder shrug, suggesting a level of C3/4. Is he complete or incomplete now? One might say that he was a complete and now is an incomplete.

Wise.ds

[George78]

Hello,
Concerning genital sensation, if I can feel pain when I pinch my bollocks or if I can feel when my bladder is fool (I do urinate between 30 sec and 2-3 minutes after the feeling), can I say I'm ASIA B ?...
Besides, can anyone tell what are the 10 key muscles for both ASIA C&D ?...
Thanks in advance
George

[This message was edited by George du Chesne on 08-24-03 at 07:55 AM.]

[SCI-Nurse]

Here is the ASIA tool. It lists the criteria as well as the muscles and sensory areas tested, and is included in an article that Dr. Young wrote for this site:

SCI Levels and Classificiation (http://carecure.rutgers.edu/Spinewire/Articles/SpinalLevels/SpinalLevels.html)

[Duke]

I dont mean to sound stupid but what is the difference between the two.
I`m sure someone will make me look stupid. Duke

[timmy!!]

Originally posted by Duke:

I dont mean to sound stupid but what is the difference between the two.
I`m sure someone will make me look stupid. Duke

No need to...

[dogger]

Duke , complete/incomplete was a description used before Asia classifications came in . it was used in 2 ways whether or not the spinal cord was completely or incompletely severed and whether there was any function/sensation below the level of injury [ incomplete] or no function/sensation [complete] . this function/sensation ability was its main use . i hope this explanation is clear .
thank you ,
dogger

every day i wake up is a good one .

[gvinton]

At the time this question was first asked, I was "AB".

[Duke]

Thx Dogger,I wish there was more people like you in the world.http://sci.rutgers.edu/forum/images/smilies/smile.gif Duke

[jb]

I,too, can feel when I have to urinate but I have to be EXTREMELY full. I don't know why I don't have accidents in this case a lot. Also, when I think I had a bowel accident I feel the back of my pants on my butt to see if I did and I can sort of feel it but it's not right. I guess this doesn't classify me into the incomplete populatin, huh?