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Thread: question about scinetusa and injury level vs. asia class

  1. #1
    Senior Member lunasicc42's Avatar
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    question about scinetusa and injury level vs. asia class

    when I first got hurt like 16 years ago I didn't have any physical therapy or rehab due to the severity of my injury, I spent like the immediate whole first seven months in ICU and the next like 6 months in the "regular" part of the hospital but no rehab maybe due to severe malnutrition and lingering stage IV bedsores... Leading to my question: I don't remember ever having a proper ASIA exam, I had like a half-ass one ten years ago where I think I was classified as C456 ASIA A, so by one neurological level I wouldn't fit the inclusion criteria for the upcoming scinetusa trials... I have been doing out-patient physical rehab for like the last 4 years and I am physically better off than I was way back when I had my last ASIA exam... My question is: is it worth getting a new ASIA exam to see if I improved one measly neurological level and therefore would be eligible for scinetusa? My thinking is that through rehab; my ASIA class may have improved but not the neurological level from C4,that can't physically improve, can it?
    Would it be worth getting a new ASIA exam?
    "That's not smog! It's SMUG!! " - randy marsh, southpark

    "what???? , you don't 'all' wear a poop sac?.... DAMNIT BONNIE, YOU LIED TO ME ABOUT THE POOP SAC!!!! "


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  2. #2
    Hey Anthony,

    It's all about where the damage to the cord is. The cells need to be injected above the injury site so they interact with the intact cord. If you were to inject into the injury site, they would be walled off by dead tissue. Neurosurgeons don't yet want to inject above C4 because the phrenic nucleus that controls breathing is located there.

    So, if you started at C4 (shown on original MRI), and have regained function, ASIA exam says you are now C5, does that mean C5 is now intact and can be injected above? If so, do you still qualify as ASIA A, which is required? Great question, i'll find out

  3. #3
    I'm a little confused. How was your injury rated at C456? You can have two levels (right and left side), not 3. Are you sure that was not your fractures? Often people get the level of vertebral injury confused with neurologic level. Although these are often nearly identical in a cervical injury (although you don't have a C8 vertebrae, you do have C8 cord segments, which is additionally confusing), it is less and less common the lower you go down the spine. The L3 and L2 cord segments are right next to T12 vertebrae, for example.

    Your neurologic level is not established by MRI, but by the ISNCSCI (formerly the ASIA) exam, and your level established by the lowest level of the cord segment which has a grade 3 or better movement and normal sensation. So, if you have normal sensation at C5 (outer edge of the inside of your elbow) and at least a grade 3 elbow flexion, you would be classified as C5.

    You can see the ISNCSCI exam worksheet here. It is also critical that the exam be done by someone who has been properly trained in conducting the exam, usually through the course and certification test on the ASIA website, as well as hands-on instruction by someone who is also certified. Your level can change, especially during the first 1-2 years, often root sparing results in regaining 1-2 levels. You can also loose levels through cord compression or a syrinx. It is a good idea to have an ISCNSCI exam done every couple of years to determine if you may have problems in those areas.

    https://asia-spinalinjury.org/wp-content/uploads/2016/02/International_Stds_Diagram_Worksheet.pdf



    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  4. #4
    There is a good paper on this by Wise here https://www.travisroyfoundation.org/...lassification/

  5. #5
    Senior Member lunasicc42's Avatar
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    Thanks all, it Sounds like it would indeed benefit me to get an updated official ASIA exam.
    Thanks SCI-Nurse
    "That's not smog! It's SMUG!! " - randy marsh, southpark

    "what???? , you don't 'all' wear a poop sac?.... DAMNIT BONNIE, YOU LIED TO ME ABOUT THE POOP SAC!!!! "


    2010 SCINet Clinical Trial Support Squad Member
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  6. #6
    Senior Member lunasicc42's Avatar
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    oh, and SCI-Nurse, I can see how there might be discrepancies in my story... It was so long since that half-assed ASIA exam, I am certainly misremembering some details
    "That's not smog! It's SMUG!! " - randy marsh, southpark

    "what???? , you don't 'all' wear a poop sac?.... DAMNIT BONNIE, YOU LIED TO ME ABOUT THE POOP SAC!!!! "


    2010 SCINet Clinical Trial Support Squad Member
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  7. #7
    Senior Member lunasicc42's Avatar
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    Quote Originally Posted by Jim View Post
    Hey Anthony,

    It's all about where the damage to the cord is. The cells need to be injected above the injury site so they interact with the intact cord. If you were to inject into the injury site, they would be walled off by dead tissue. Neurosurgeons don't yet want to inject above C4 because the phrenic nucleus that controls breathing is located there.

    So, if you started at C4 (shown on original MRI), and have regained function, ASIA exam says you are now C5, does that mean C5 is now intact and can be injected above? If so, do you still qualify as ASIA A, which is required? Great question, i'll find out
    thanks Jim, please do that
    "That's not smog! It's SMUG!! " - randy marsh, southpark

    "what???? , you don't 'all' wear a poop sac?.... DAMNIT BONNIE, YOU LIED TO ME ABOUT THE POOP SAC!!!! "


    2010 SCINet Clinical Trial Support Squad Member
    Please join me and donate a dollar a day at http://justadollarplease.org and copy and paste this message to the bottom of your signature

  8. #8
    As noted above, the exam is no longer called the ASIA exam (although it was developed and revised by both ASIA and ISCoS). It is now called the ISNCSCI (International Standards for the Neurological Classification of Spinal Cord Injury). If a clinician does not use that term, they most probably are not an expert nor certified in the use of this exam.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  9. #9
    Senior Member lunasicc42's Avatar
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    Quote Originally Posted by SCI-Nurse View Post
    As noted above, the exam is no longer called the ASIA exam (although it was developed and revised by both ASIA and ISCoS). It is now called the ISNCSCI (International Standards for the Neurological Classification of Spinal Cord Injury). If a clinician does not use that term, they most probably are not an expert nor certified in the use of this exam.

    (KLD)

    Noted
    "That's not smog! It's SMUG!! " - randy marsh, southpark

    "what???? , you don't 'all' wear a poop sac?.... DAMNIT BONNIE, YOU LIED TO ME ABOUT THE POOP SAC!!!! "


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