Questions
2–3 descriptive questions in university theory papers
Difficulty
Medium-Hard
Importance
High yield for BPT/MBBS clinical viva and pathology exams
Overview
Spinal Cord Injury (SCI) refers to damage to the spinal cord that results in loss of sensory and motor function below the level of injury. Mastery of the neurological classification and rehabilitation hierarchy is essential for clinical exams and board assessments, as it defines long-term patient dependency and functional potential.
ASIA Impairment Scale (AIS)
The ASIA scale is the international standard for determining the completeness of spinal cord injuries. It categorizes injuries from A (complete) to E (normal) based on neurological and motor assessments.
- AIS A: Complete; no sensory or motor function preserved in sacral segments S4-S5.
- AIS B: Sensory Incomplete; sensory but no motor function preserved below the level of injury.
- AIS C: Motor Incomplete; motor function preserved, more than half of key muscles below level have grade < 3.
- AIS D: Motor Incomplete; motor function preserved, at least half of key muscles below level have grade 3 or more.
- AIS E: Normal; sensory and motor function recovered.
Levels of Injury and Clinical Features
Injuries are classified by the lowest spinal segment with normal motor and sensory function on both sides of the body. Tetraplegia typically results from cervical injuries (C1-C8), while paraplegia results from thoracic, lumbar, or sacral damage.
- C1-C4: Requires mechanical ventilation; total dependence for ADLs.
- C5-C6: Elbow flexion (biceps) and wrist extension preserved; potential for independent wheelchair propulsion.
- C7-C8: Elbow extension (triceps) and finger flexion/extension; high level of independence in self-care.
- T1-T9: Full upper extremity function; limited trunk control.
- T10-L1: Improved trunk stability; potential for community ambulation with orthotics.
- L2-S5: Variable lower extremity function; focus on gait training and bowel/bladder management.
Rehabilitation Goals
Rehabilitation goals are dictated by the neurological level of injury (NLI) and functional ability. Therapists focus on compensatory strategies for higher lesions and restorative function for lower incomplete lesions.
- Prevention of secondary complications like pressure sores and DVT.
- Respiratory muscle training for high-cervical injuries.
- Tenodesis grip training for patients with C6 injuries.
- Transfer training and wheelchair skill acquisition.
- Neurogenic bladder and bowel management protocols.
Exam Tip
Always state that the neurological level is the last level with 'normal' function, meaning grade 3/5 or higher for motor and intact sensation.
Common Mistakes
- Confusing the NLI (Neurological Level of Injury) with the vertebral level of fracture.
- Failing to distinguish between AIS A (complete) and AIS B (sensory incomplete) in clinical scenarios.
- Neglecting the importance of sacral sparing (S4-S5) as the primary indicator for classifying an injury as incomplete.
More Revision Notes
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