Categorizing Spinal Cord Injuries with Peggy Ford

In this episode, MEC’s Senior National Medical Catastrophic Consultant Peggy Ford unpacks the complex world of the American Spinal Injury Association (ASIA) Impairment Scale. Peggy breaks down this essential clinical tool that standardizes how healthcare professionals evaluate and communicate about spinal cord injuries. This includes:

• The three crucial components of the ASIA scale 
• The scoring system for sensation 
• Categories for measuring muscle strength 
• Insights into how clinicians map injury severity  
• The five grade classifications for the assessment tool 
• How classifications drive treatment decisions, rehabilitation strategies, and recovery expectations. 

Listen now to understand the language that shapes spinal cord injury management and gain valuable knowledge applicable to workers' compensation and catastrophic claim oversight.

Chapters

• 0:00 Introduction to Expert Insights
• 0:36 Understanding the ASIA Scale Basics
• 1:42 Sensory and Motor Assessment Methods
• 4:21 Five Grades of Spinal Injury Severity
• 6:13 Clinical Applications and Episode Closing

Transcript

Sara Hance: 0:02

Hello, this is MEC Connect Expert Insights, a companion series to our main MEC Connect podcast for Midwest Employers Casualty. I'm Sara Hance and in these Expert Insights episodes you'll hear from subject matter experts as they share practical tips and strategies on a variety of topics related to workers' comp and claims management. Today, Peggy Ford, Senior National Medical Catastrophic Consultant, will discuss the American Spinal Injury Association Impairment Scale, commonly referred to as the Asia Impairment Scale. Now let's hear from Peggy.

Peggy Ford: 0:36

Good day everyone. Peggy Ford, senior National Medical Catastrophic Consultant for Midwest Employers Casualty here After 30 plus years working as a case manager in a multitude of disability situations. Today we're going to delve into an essential tool used in an assessment and management of spinal cord injuries the American Spinal Injury Association Impairment Scale, commonly known as ASIA. This scale is pivotal for clinicians to determine the extent of spinal cord injuries and to plan appropriate treatments, emergently and ongoing. ASIA is a comprehensive classification system developed to evaluate and describe the severity of spinal cord injuries. It standardizes the assessment of motor and sensory functions, enabling a common language among healthcare providers. Understanding the scale is crucial for anyone working with individuals with spinal cord injury. Let's break down the scale into its three main components sensory, motor and neurological. Level of injury, to help identify areas of sensory loss or impairment and the corresponding spinal cord level.

Peggy Ford: 1:52

The sensory examination involves testing 28 dermatomes, which are areas of skin that connect to a specific nerve root on your spine, on each side of the body, for two types of sensation light touch and pinpricks. Each dermatone is scored from zero to two. Zero is absent sensation, one is impaired sensation and two is normal sensation. The motor examination assesses the strength of 10 key muscle groups on each side of the body, focusing on specific muscle actions such as elbow flexion, wrist extension and hip flexion. Muscle strength is scored on a scale from 0 to 5. 0 is total paralysis. 1 is a palatable or a visible contraction. Two is active movement full range of motion with gravity eliminated. Three is active movement full range of motion against gravity. Four is active movement full range of motion against gravity and adding in moderate resistance in a muscle specific position. Five is active movement. All of the above and resistance is considered normal if identified inhibiting factors are not present, for example pain and disuse or severe pain, amputation or a contracture of 50% or more of the normal range of motion. A contracture is defined as a condition of shortening or hardening of muscle, tendon or other tissue, which leads to deformity and rigidity of the joints.

Peggy Ford: 3:58

By evaluating these muscle groups, clinicians can pinpoint motor deficits and their corresponding spinal cord levels. Then, finally, the neurological level of injury is determined by identifying the lowest segment of the spinal cord with normal sensory and motor functions on both sides of the body. Determining this level is crucial as it guides the prognosis and rehabilitation strategy. For example, an injury at the cervical level typically results in a more severe impairment than one at the lumbar level. So moving on, we'll now discuss categorizing the severity of the spinal cord injury into five grades.

Peggy Ford: 4:36

Grade A is complete injury injury into the five grades. Grade A is complete injury there is no sensory or motor function preserved below the level of injury. So this grade indicates a total loss of function below the injury level, which often leads to significant challenges and rehabilitation. Grade B is a complete injury where sensory but not motor function is preserved below the neurological level and it also includes the sacral segments S4, s5. So patients can feel sensations below the injury site but they lack motor control. Grade C incomplete Motor function is preserved below the neurological level and more than half of the key muscles below that level have a muscle grade less than 3. So this grade indicates that while some motor function is routine, it is weak. Number 5 is considered normal muscle strength. Grade B incomplete injury. Grade B incomplete injury Motor function is preserved below the neurological level and at least half of the key muscles below the level have a muscle grade of three or more. So patients in this grade have stronger motor function, which often leads to better rehabilitation outcomes. Grade E is normal Sensory and motor functions are considered normal and unhindered. This category is used when a person has had a previous spinal cord injury but has now recovered normal function.

Peggy Ford: 6:08

ASIA is not just a diagnostic tool. It is considered a cornerstone in the management of spinal cord injury. It helps in prognostication, providing a clear picture of the injury. Clinicians can better predict recovery and functional outcomes, treatment planning, the detailed assessment guides, rehabilitation strategies, helping to tailor interventions to the patient's specific needs, and work to ensure the best outcome for the injured patient. Communication Standardizes the language used to describe spinal cord injury, facilitating clear communication among all individuals discussing the injury, including healthcare providers, researchers and insurers. In summary, the ASIA Impairment Scale is an invaluable tool in the assessment and management of spinal cord injuries. It provides a standardized method to evaluate and classify the extent of spinal cord injury, guiding treatment plans, clinical trials and research to advance spinal cord injury treatment, prognostication and communication. As healthcare professionals, understanding and utilizing the scale can significantly impact the quality of care provided to patients with spinal cord injury. Thank you for your attention. If you have any questions or would like to discuss this further, I'm available to answer any further questions.

Sara Hance: 7:34

Thank you for tuning in to MEC Connect Expert Insights. I'm Sara Hance from Midwest Employers Casualty. We hope you found Peggy's insights on the ASIA Impairment Scale valuable. Stay tuned for more from MEC Connect and more expert insights. Thank you.