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Thread: Awkward question

  1. #1
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    Awkward question

    I was diagnosed ASIA A in the first days of my SCI, but nether my wife nor I could recall them doing the anal wink test. So on a whim, we did this at home and I can actually squeeze my anal sphincter on command even though I cannot feel anything down there.

    Does that make me an ASIA C and, if so, what are the implications?
    T3-T6 complete since Sept 2015.

  2. #2
    Anal wink is a reflex. What you are describing is voluntary anal contraction. This is not one of the "key muscles" scored under the ASIA (actually the ISNCSCI now) exam, although testing it is part of the exam. Do you also have sensation at the anus? This would give you an AIS B

    In order to be classified as an AIS C, you must have half the "key" muscles below the neurological level of injury graded as less than 3/5. So you would need to have voluntary weak movement in at least 1/2 of those muscles.

    This lists key muscles on the left:



    (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.

  3. #3
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    Thanks KLD

    I'll get my latest scores from PT this week but...

    I have gravity-eliminated voluntary motor in my:
    - hip-flexors: I can swing during gait training provided I successfully hike my hip enough to overcome foot drop. On a powder board I can swing strongly, but intermittently forward, much less backward (glutes).
    - knee-extensors: much more limited but not zero. They intermittently (well maybe 10% of the time) hold stance phase without a knee block.
    - PTs can feel ankle flexors, but no visible motion, no dorsiflexion of the ankle
    - no toe movement

    So, if I've counted correctly, that's half.

    I have limited cold and pressure sensation below T7 but only a couple inches worth and no blunt or prick touch sensation at all. I have no direct sensation during gait training but my propriaception is good enough that I can tell when my knees are not in hyperextension during stance phase.

    We do updates on my movement scores regularly during the "covered by insurance" part of the year (read: jan-feb) after I go to self-pay we don't do that as much as I'd rather spend my money on walking.
    T3-T6 complete since Sept 2015.

  4. #4
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    KLD:

    From my PTs

    Hip flexion 2/5 bilaterally
    Hip extension 2-/5 bilaterally (movement in approximately 2/3 of available range)
    Knee extension 2-/5 (L); 2/5 (R)
    Knee flexion 2-/5 bilaterally (movement in approximately 2/3 of available range)
    Ankle dorsiflexion 1/5 bilaterally
    Ankle plantarflexion 1/5 bilaterally
    T3-T6 complete since Sept 2015.

  5. #5
    If the PT doing your exam was properly trained in how to do it, then it would appear that you are currently an AIS C, IF you have some anal sensation.

    (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.

  6. #6
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    Quote Originally Posted by SCI-Nurse View Post
    If the PT doing your exam was properly trained in how to do it, then it would appear that you are currently an AIS C, IF you have some anal sensation.

    (KLD)
    Nope. No sensation. Only volitional contraction of the anal sphincter. Pretty much no sensation below T7.
    T3-T6 complete since Sept 2015.

  7. #7
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    So you cannot be sensory complete and motor incomplete? Or at least, if you are you're still ASIA A?
    Very confusing since ASIA A includes no motor in sacral segments.
    T3-T6 complete since Sept 2015.

  8. #8
    S-1 is the only sacral motor segment scored (ankle plantarflexion).

    (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
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    Thanks again KLD, but I'm still confused (sorry).
    The definition above and in Wise's papers is "ASIA A is defined as a person with no motor or sensory function preserved in the sacral segments S4-S5"
    So if I have voluntary sphincter contraction that precludes ASIA A since that's motor in S4, right?
    T3-T6 complete since Sept 2015.

  10. #10
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    Quote Originally Posted by SCI-Nurse View Post
    If the PT doing your exam was properly trained in how to do it, then it would appear that you are currently an AIS C, IF you have some anal sensation.

    (KLD)
    ok anal sensation like when doing a a bowel program or cleaning of mucus out if so I have lots feeling hurts like hades so I would be asia c?

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