SPINAL CORD INJURY ASSESMENT
ROOHI ABBAS
ASSISTANT PROFESSOR
LAHORE COLLEGE OF PHYSICALTHERAPY
ASSESSMENT
Assessment is the first step in physiotherapy
management of people with SCI. There are 5 important
components of assessment. These components are:
1. Subjective assessment
2. Assessment of impairments
3. Assessment of activity limitations
4. Assessment of participation restrictions
Followed at a later date by:
5. reevaluation of any of the above
1. Subjective assessment
•
A detailed subjective assessment involves
several key factors including:
a) history of presenting condition
b) surgical history and precautions
c) past medical history and medications
d) social history
e) environmental factors
f) patient goals and expectations
2. Assessment of impairments
– Impairments may be identified during
assessments of:
a) strength
b) joint mobility
c) motor skill
d) cardiovascular fitness
e) respiratory function
f) pain
g) spasticity and spasm
h) sensation
a) Strength:
Strength can be assessed using manual muscle tests,
repetition maximum testing or hand-held myometry.
b) Joint mobility:
Joint mobility can be assessed by measuring active or
passive joint range of motion.
c) Motor skill:
Motor skill can be assessed by observing
performance of functional tasks such as bed
mobility, transfers, wheelchair mobility, walking
and upper limb activities
d) Cardiovascular fitness:
Cardiovascular fitness can be
assessed using standardized fitness
assessments.eg Borg scale of
perceived exertion
e) Respiratory function:
Respiratory function can be
assessed by a comprehensive
respiratory examination.
f) Pain
Pain can be assessed by a detailed
subjective and objective assessment.
g) Spasticity and Spasm
Spasticity and spasm can be assessed
by observation and using measurement
tools such as the
Tardieu scale
modified Ashworth scale
h) Sensation
Poor or absent sensation can be assessed
using the sensory assessment of the
International Standards for Neurological
Classification of SCI. (ASIA Scale)
3. Assessment of activities
Key impairments are associated with activity
limitations. Commonly assessed domains
include:
a) general mobility (including bed mobility and
transfers)
b) wheelchair mobility
c) gait
d) upper limb and hand function
4. Assessment of participation restrictions
It is most useful to assess the participation
domains that the patient is interested in.
Commonly assessed participation domains
include:
a) work
b) leisure
c) family
d) sport
5. Reevaluation
Reevaluating outcomes determines whether
interventions should continue or change. Similar
to the initial assessment outcomes can be
measured with respect to:
• impairments
• activity limitations
• participation restrictions
AMERICAN SPINAL CORD INJRY ASSESSMENT(ASIA)
SCALE
AMERICAN SPINAL CORD INJRY ASSESSMENT(ASIA)
SCALE
There are 2 key sets of tests required as part
of the assessment. They are the:
1.motor assessment
2.sensory assessment
Motor assessment
The important points about
the motor assessment are:
1. It involves testing 5 key upper limb muscle groups
and 5 key lower limb muscle groups
2. Each muscle group represents a myotome (for
example, elbow flexors represent C5 and wrist
extensors represent C6)
3. Testing is done with the patient in a supine position
4. Each muscle group is tested using the standard 6
point manual muscle testing scale
• Muscle Function Grading
0= total paralysis
1= palpable or visible contraction
2= active movement, full range of motion (ROM) with gravity eliminated
3= active movement, full ROM against gravity
4= active movement, full ROM against gravity and moderate resistance in a muscle
specific position
5= (normal) active movement, full ROM against gravity and full resistance in a
functional muscle position expected from an otherwise unimpaired person
5* = (normal) active movement, full ROM against gravity and sufficient resistance to
be considered normal if identified inhibiting factors (i.e. pain, disuse) were not
present
NT = not testable (i.e. due to immobilization, severe pain such that the patient
cannot be graded, amputation of limb, or contracture of > 50% of the normal ROM)
Sensory Assesment
1.The important points about the sensory assessment are:it
involves testing 28 locations on each side of the body
2.each location represents a dermatome (for example, behind
the ear represents C2)
3.each location is tested separately for light touch and pinprick
4.light touch and pinprick is scored on a 0 to 2 scale
0 = absent
1 = impaired
2 = normal
• For example, the following locations are
used to test light touch and pinprick for C6,
C7 and C8.
The results of the motor and sensory assessments are
used to:
• determine a left and right motor level, a left and right
sensory level and a neurological level. The neurological
level is defined as the most caudal level (sensory or
motor) with normal function.
• classify patients’ SCI as complete or incomplete
according to the ASIA Impairment Scale (AIS) where:
• Complete: no motor or sensory function in S4/5.
• Incomplete: some motor or sensory function in S4/5.
• Motor and sensory function in S4/5 is critical
to the classification of SCI.S4/5 refers to the
anus. It is tested by:
• Motor: determining if a patient can voluntarily
contract the anal sphincter.
• Sensory: determining if a patient has light
touch or pinprick sensation in the skin around
the anus OR if a patient can feel pressure
applied internally to the wall of the anus.
AISA Impairment Scale:
• The definition of each AIS level is technical. A broad definition
is:
• AIS A - Complete no motor or sensory function in S4-S5.
• AIS B - Sensory Incomplete sensory function in S4-S5.
• AIS C - Motor Incomplete sensory function in S4-S5 and motor
function more than 3 levels below the motor level OR motor
function S4-S5. In addition, less than grade 3 strength in more
than half the key muscles below the neurological level.
• AIS D - Motor Incomplete sensory function in S4-S5 and motor
function more than 3 levels below the motor level OR motor
function S4-S5. In addition, grade 3 or more strength in more
than half the key muscles below the neurological level.
• AIS E - normal motor and sensory function.
