ASIA Impairment Scale: The American Spinal Injury Association Impairment Scale is a standardized neurological examination used by the rehabilitation team to assess the sensory and motor levels which were affected by the spinal cord injury. Read more.
Autonomic Dysreflexia: ADR is a condition caused by a noxious stimulus below the level of injury causing the nervous system to react in a way which causes the blood pressure to rise to a dangerous level. A few common causes of ADR are, but not limited to, a full bladder, full bowel, pressure sores, or any pain. A few signs of ADR include but are not limited to, high blood pressure, pounding headache, flushed face, sweating above the level of injury, slow pulse, and/or "goose bumps." ADR is treated by finding and removing the cause. The individual should sit up immediately when experiencing symptoms of ADR. Medical professionals should be consulted for alternative treatments to assist in resolving autonomic dysreflexia and control blood pressure if signs continue.
Pressure relief: Prevention of skin breakdown is very important and becomes a big part of the daily routine in rehab. Pressure relief over bony prominences can be done by repositioning the body every 15-30 minutes when in a sitting position and at least every two hours when in bed. Pressure relief prevents skin breakdown and pressure ulcers from forming. The rehab team educates each patient and his/her family and friends on the technique most adequate for them to get pressure relief. Source: Yes You Can! A guide to self-care for persons with Spinal Cord Injury, Fourth Edition, Paralyzed Veterans of America 2009
Tetraplegia (preferred to “quadriplegia”): This term refers to impairment or loss of motor and/or sensory function in the cervical segments of the spinal cord due to damage of neural elements within the spinal canal. Tetraplegia results in impairment of function in the arms as well as typically in the trunk, legs and pelvic organs, i.e. including the four extremities. It does not include brachial plexus lesions or injury to peripheral nerves outside the neural canal.
Paraplegia: This term refers to impairment or loss of motor and/or sensory function in the thoracic, lumbar or sacral (but not cervical) segments of the spinal cord, secondary to damage of neural elements within the spinal canal. With paraplegia, arm functioning is spared, but, depending on the level of injury, the trunk, legs and pelvic organs may be involved. The term is used in referring to cauda equina and conus medullaris injuries, but not to lumbosacral plexus lesions or injury to peripheral nerves outside the neural canal.
Dermatome: This term refers to the area of the skin innervated by the sensory axons within each segmental nerve (root).
Myotome: This term refers to the collection of muscle fibers innervated by the motor axons within each segmental nerve (root).
Sensory level: The sensory level is determined by performing an examination of the key sensory points within each of the 28 dermatomes on each side of the body (right and left) and is the most caudal, normally innervated dermatome for both pin prick (sharp/dull discrimination) and light touch sensation. This may be different for the right and left side of the body.
Motor level: The motor level is determined by examining a key muscle function within each of 10 myotomes on each side of the body and is defined by the lowest key muscle function that has a grade of at least 3 [on manual muscle testing (MMT) in the supine position], providing the key muscle functions represented by segments above that level are judged to be intact (graded as a 5 on MMT). This may be different for the right and left side of the body.
Neurological level of injury (NLI): The NLI refers to the most caudal segment of the spinal cord with normal sensory and antigravity motor function on both sides of the body, provided that there is normal (intact) sensory and motor function rostrally. The segments at which normal function is found often differ by side of the body and in terms of sensory and motor testing. Thus, up to four different segments may be identified in determining the neurological level, i.e., R(ight)-sensory, L(eft)-sensory, R-motor, L-motor. The single NLI is the most rostral of these levels.
Skeletal level: This term has been used to denote the level at which, by radiographic examination, the greatest vertebral damage is found. The skeletal level is not part of the current ISNCSCI because not all cases of SCI have a bony injury, bony injuries do not consistently correlate with the neurological injury to the spinal cord, and this term cannot be revised to document neurological improvement or deterioration.
Sensory scores: This term refers to a numerical summary score of sensory function. There is a maximum total of 56 points each for light touch and pin prick (sharp/dull discrimination) modalities, for a total of 112 points per side of the body. This can reflect the degree of neurological impairment associated with the SCI.
Motor scores: This term refers to a numerical summary score of motor function. There is a maximum score of 25 for each extremity, totaling 50 for the upper limbs and 50 for the lower limbs. This score can reflect the degree of neurological impairment associated with the SCI.
Incomplete injury: This term is used when there is preservation of any sensory and/or motor function below the neurological level that includes the lowest sacral segments S4-S5 (i.e. presence of “sacral sparing”). Sensory sacral sparing includes sensation preservation (intact or impaired) at the anal mucocutaneous junction (S4-5 dermatome) on one or both sides for light touch or pin prick, or deep anal pressure (DAP). Motor sacral sparing includes the presence of voluntary contraction of the external anal sphincter upon digital rectal examination.
Complete injury: This term is used when there is an absence of sensory and motor function in the lowest sacral segments (S4-S5) (i.e. no sacral sparing).
Zone of partial preservation (ZPP): This term, used only with complete injuries, refers to those dermatomes and myotomes caudal to the sensory and motor levels that remain partially innervated. The most caudal segment with some sensory and/or motor function defines the extent of the sensory and motor ZPP respectively and are documented as four distinct levels (R-sensory, L-sensory, R-motor, and L-motor).