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Thread: Am I ASIA A or B ?...

  1. #1

    Am I ASIA A or B ?...

    I can feel pain when I pinch my bollocks and 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 ?...

  2. #2
    George, the criterion is anal sensation or sphincter contraction but I would say that you are very close to being incomplete. I was going to say 99% incomplete but realized that this is not true. In my experience, people who can feel when their bladders are full are incomplete or will be.


  3. #3
    Thanks a lot, Wise...

  4. #4
    There continues to be, in my opinion, misunderstanding about what the ASIA categories mean and even how they should be applied. The categorization was set up so that it can be applied unambiguously. The problem with previous definitions of complete and incomplete spinal cord injury was ambiguity.

    Before the ASIA definition of A category was set up in 1991, clinicians were rating completeness of spinal cord injury without clear criteria. For example, suppose that somebody had a C4/5 injury with initially no motor or sensory function at C6 or below. Over time, suppose that person recovers sensation down to C8 and get some patches of touch sensation or deep pressure sensation in the abdomen and even legs but does not recover anal sensation or voluntary sphincter contraction. By the way, this is very common. A majority of people with so-called "complete" spinal cord injury recover some function below the injury level and often more than two segments below the original injury level.

    Some clinicians would rate such a person as "complete" while others would rate the person as "incomplete". This was an inappropriate situation for a supposedly objective clinical descriptor for spinal cord injury. One possibility was deciding on a given number of levels below the injury site that would be required for a person to be called "incomplete". The ASIA Committee looked at this issue carefully and realized that any criterion other than the bottom-most segment would be arbitrary. As long as a person has a segment level, below which there was no motor or sensory function, that person would be called complete. Thus, this was how the ASIA definition of "complete" was made.

    After that criterion was established, several papers were published concerning the extent to which a person with an ASIA A classification would recover. It turns out that there was a statistically high significant difference between a person with an ASIA A classification and those with all other classifications. This of course does not mean that all people who are ASIA A will not recover anything below the injury. But, we knew this already. A certain percentage of people with so-called "complete" spinal cord injuries do recover.

    Recently John Ditunno and his colleagues (Burns, et al. 2003) published a paper that evaluated the conditions under which the ASIA A classification was less predictive. They found that 6.2% of people who were classified ASIA A converted to ASIA B but none exhibited motor recovery (ASIA C or D) by one week after injury.

    They identified several factors that influenced exam reliability and found that those patients who had these factors (which included such things as concomitant head injury) had a higher incidence, i.e. 9.3% chance, of conversion to ASIA B by 1 week after injury.

    What is very interesting is the proportion of patients who had factors that potentially affected exam reliability. About a third of othe patients had such factors.

    At a year, 17.4% of patients with factors that affected reliability of the initial examination converted to incomplete and 13% converting to ASIA C or D. Patients without such factors had only a 6.7% chance of conversion to incomplete injury by one year and none converted to ASIA C or D.

    They concluded that it is possible to identify a subset of patients who have a negligible chance of motor recovery at one year after injury. As I pointed out earlier, many patients continue to recover more function up to 2 or more years after injury. Thus, the above statistics are conservative. The likelihood of a person who is initially classified as ASIA A converting to incomplete status by one year is quite high.


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