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Thread: Question about ASIA classification

  1. #1
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    Question about ASIA classification

    Dear all,

    Just thought you might be able to help me understand the ASIA classifications. I saw you put the list up in Ian's thread, and I remembered a question I had about it.

    I understand that for ASIA A, rectal sensation is the key determining factor.

    But what I don't get is how the lack of rectal sensation can imply things about the entire cord below the level of injury.

    The way I see it is that messages travel down the cord, and when they get to where they're going, they stop.

    I would think that if messages are getting to, say, L5, wouldn't you be better off testing for sensation/movement near that area than at the very bottom of the cord?

    How does testing for sensation/movement at the lowest section of the cord imply that no messages are getting below the level of injury?


    Maybe I'm missing something.

    Sincerely,

    Dave

  2. #2
    Dave,

    The ASIA A classification means that there is some level of the spinal cord below which there is no sensation or voluntary function. Since the S4/5 is the lowest spinal cord segment and it is tested by the presence of anal sensation and voluntary anal contraction, a person is an ASIA A only if and when there is absent anal sensation and no voluntary anal contraction.

    Many studies have now shown that absence of S4/5 sensation and voluntary anal sphincter contraction correlate with more severe injuries and less recovery of function than people who have such sensation and movement.

    Note that ASIA B (sensory incomplete) and ASIA C both require the presence of anal sensation or the patient would be classified as an ASIA A.

    Wise.

    Quote Originally Posted by pianodave
    Dear all,

    Just thought you might be able to help me understand the ASIA classifications. I saw you put the list up in Ian's thread, and I remembered a question I had about it.

    I understand that for ASIA A, rectal sensation is the key determining factor.

    But what I don't get is how the lack of rectal sensation can imply things about the entire cord below the level of injury.

    The way I see it is that messages travel down the cord, and when they get to where they're going, they stop.

    I would think that if messages are getting to, say, L5, wouldn't you be better off testing for sensation/movement near that area than at the very bottom of the cord?

    How does testing for sensation/movement at the lowest section of the cord imply that no messages are getting below the level of injury?


    Maybe I'm missing something.

    Sincerely,

    Dave

  3. #3
    ". . .and it is tested by the presence of anal sensation and voluntary anal contraction."

    Dr. Young -- does feeling deep pressure during every bowel program count as "sensation?"

    Thanks,

  4. #4
    Unfortunately, it doees not. In ASIA scoring the issue is feeling light touch and/or pin prick on the surface of the skin.

    RAB

  5. #5
    SCI Nurse:

    Just so that I'm clear, are you saying that even if a person can feel a suppository and/or dig. stim., if they cannot feel light touch or pinprick at the surface then they are ASIA A?

  6. #6

    ASIA Bizzarness

    I've been trying to figure this out for a long time- without success- as a so-called "walking quad" ( I tend to refer to mysef as a perpetually falling quad) (C-3-4 lesion) I have no anal sensitivity - pin prick or light touch- but still have substantial motor ability in the legs- I don't get where this puts me on the ASIA score. My physiatrist wisely suggests I ignore the scale and get back to PT. LOL

    David

  7. #7
    Brighter, RAB is right regarding the ASIA classification. This of course does not mean that deep rectal sensation is not significant. It is simply a classification system. Wise.

    Quote Originally Posted by Brighter days
    ". . .and it is tested by the presence of anal sensation and voluntary anal contraction."

    Dr. Young -- does feeling deep pressure during every bowel program count as "sensation?"

    Thanks,

  8. #8
    Quote Originally Posted by DavidHH
    I've been trying to figure this out for a long time- without success- as a so-called "walking quad" ( I tend to refer to mysef as a perpetually falling quad) (C-3-4 lesion) I have no anal sensitivity - pin prick or light touch- but still have substantial motor ability in the legs- I don't get where this puts me on the ASIA score. My physiatrist wisely suggests I ignore the scale and get back to PT. LOL

    David
    David,

    Do you have voluntary contraction of your anal sphincter? If so, you would be an ASIA D. Wise.

  9. #9
    Dr. Young,

    No I don't have control- spastic sphincter.

    Thanks,

    David

    PS Live in Old Bridge and look forward to meeting you at a future open house

  10. #10
    Senior Member keps's Avatar
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    Quote Originally Posted by Brighter days
    SCI Nurse:

    Just so that I'm clear, are you saying that even if a person can feel a suppository and/or dig. stim., if they cannot feel light touch or pinprick at the surface then they are ASIA A?
    I'd been wondering about this too. I was classed ASIA A, but as I can sort of feel something going on during bowel program (and also when I have a bowel accident), I thought it might mean I had become ASIA B.
    But, I cannot feel pinprick/light touch anywhere below injury level, so I guess I still am ASIA A?
    (I have zero motor function below lesion)

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