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Hello, thanks for your question. These exercises are better performed under supervision of a medical professional after proper assessment and diagnosis. Different conditions require different types of exercises and different intensities. I encourage you to seek medical help, you are young, and this gives you very good advantage and potential for improvement.

Dear @user-vh8fu8xn5x you are absolutely right. I just checked. I am so sorry I missed this. Basically, - We check S4-5 raw; we do not have N0000N, we have sensory but not motor function in this area. So, this is definitely not AIS A. - We check the motor level on either side; we have motor function more than 3 levels below the motor level. So, this is definitely not AIS B. - We count the number of muscles with MMT <3 or >=3 below the NLI; here we have 11 out of 16 muscles with grade >=3. So, this is AIS D. Thank you for noticing this

I assume you are talking about the example around 2:30. Remember, the motor level has to have everything above it normal. L4 has many levels above it that are not normal.

@@mahatayseerokay thank you so much

شكرا على التعليق... وفعلا، يوما ما سيكون هناك شيء بالعربي ان شاء الله... مشكلة الصوت كانت مع الكمامة في زمن الكورونا 😅

Hello, I assume you are asking about the right side, not the left side. I recently found that there is debate on this particular example at the transitional zone between regions where we do not have motor test (C4) and where we have the motor test (C5). The answer I suggested is an acceptable answer based on the rules provided: C1 - C4: we have normal sensory function (LT 2 and PP 2), so we can assume normal motor function at these levels C5: MMT = 5 C6: MMT = 4, this is the first level we encounter with motor score >= 3 and all scores above considered normal So, the motor level is C6 I hope it makes sense

Thanks for your comment. My first thought would be to recommend the wheelchair skills program, this is an online page with helpful information about managing wheelchairs. They have developed an outcome measure called the Wheelchair Skills Test which can be used to plan treatment and also check the patient's accomplishment of outcomes. This is a link to their page: wheelchairskillsprogram.ca/en/ They also have tutorial videos.

mmm... not sure I got your question right. But let me try to explain: 1. Set the NLI 2. Count the number of key muscles below NLI with MMT = 0 or 1 or 2 2. Count the number of key muscles below NLI with MMT = 3 or 4 or 5 If the majority of muscles are 0, 1, or 2, then this is AIS C If the majority of muscles are 3, 4, or 5, then this is AIS D Hope it is clear now

Thank you for this comment 👍 I didn't show the powered wheelchair because we do not have one around. If I can get one, I will record videos on its use

I just remembered a useful source on power wheelchairs. Please check the following page: www.youtube.com/@WheelchairSkillsProgram/playlists This is from Dalhousie University, they have developed a program called Wheelchair Skills Program, they have useful information and videos. This is the link to the program page: wheelchairskillsprogram.ca/en/

Thank you for bringing this up 👍 the way you described is the optimal propulsion technique 👏 unfortunately, Zaid (the guy in the wheelchair) was not demonstrating it because he kept changing directions and maneuvering around the environment. Plus, he is around 180 cm tall trying to fit in a small wheelchair 😏 So, all in all it wasn't the optimal situation for him. But, really thanks for describing the proper technique

So, I guess you mean you propel with your foot? That can be one way to go, but some patients who can't use their feet are better having them on the foot support to raise them off the floor...

@mahatayseer no I don't propel with my feet. I still use the rims. I sit back far enough in the chair to where my feet don't even touch the floor they just kind of dangle. It's great for short trips.

@@FlipMacz I see, thanks for the explanation. I understand now. Just be careful not to use this for long times, for many reasons, one of which is that keeping your feet dangling might cause shortening in the calf muscle (the big muscle on the back of the leg), which might eventually lead to restriction in ankle movement.

@mahatayseer thank you! I did not know that. Yes, I use it only for quick grocery store.

Good on you for coming back to a year-old video to deliver the correct information. Thanks for the video!

@@jaredraga thanks for your positive input Jared 🤓

Thank you Elman. Your questions are answered below.

This is what I learned in school, but I always wonder why Zone of partial preservation only applicable for ASIA A. We can clearly see key muscles being more than 3/5 below NLI as well. So why can't zone of partial preservation be there in ASIA B, C, D?

Dear Elman, Thank you for your questions. Actually, what you mentioned about determining ZPP only in AIS A was true in the previous version of the ISNCSCI. In the 2019 revision, new rules for reporting the ZPP are followed. These are the ones I explained in my videos. For further details about this revision, please check the following website: asia-spinalinjury.org/isncsci-2019-revision-released/ Hope this helps

Thank you so much for sharing this. I read it. Making sense. I think this revised version is much better. I hope NPTE exam will take that into consideration coz in our book we still see old version of ZPP.

@@elmanahmed6117 I see. If I were I would email them to enquire about that. Good luck in the exam 👍

Glad to hear this 🤩

This is true. There are 2 positions for testing grades 2, 1, and 0; the first is with the arm resting on the exam table (here the elbow would be fully extended), and the alternate position is with the arm above the abdomen (here the elbow is flexed to 90 degrees). Both were mentioned in the video, and I chose to apply the one with the arm above the abdomen.

Can't you hold with only the right arm? Plus, depending on the extent to which you can move your left arm, always try to engage it in movement. There's a treatment approach called constraint-induced movement therapy, please check it out and see with your therapist if you are a good candidate for it. Not everyone is, but it can be helpful sometimes. Wish you the best health

You use them when you want to facilitate movement; say for example your patient has limited range of reach (measured by seated forward reach test), you do dynamic reversal and aim to gradually increase the range of the movement. We call this "increments" of range of motion. On the contrary, if your patient has uncontrolled sway due to ataxia, you start with dynamic reversal doing the movement within the patient's range of sway, and then gradually decrease the range of the movement. This is called "decrements" of range of motion.

@@mahatayseer Is that what you call slow reversal when you decrement the ROM?

@@mahatayseer I saw both terms that's why asking. Both dynamic and slow reversal.

@@elmanahmed6117 Do you mean "stabilizing" reversal? In dynamic reversal, we allow movement while in stabilizing reversal we allow isometric contraction, so no movement is allowed. I'm not sure if I had mentioned slow reversals. Please point that to me if I had.

Hello, Thank you for your comments which I assume are related to the first example. Actually, when determining the sensory and motor levels at the very first step, we do so for the right and left separately. We do not determine the levels bilaterally like you suggested. So, we end up determining 4 levels (sensory level on right, sensory level on left, motor level on right, and motor level on left). Please note that we have 4 spaces to fill on the lower left corner of the sheet (steps #1 and 2). As for the NLI, by definition it is the most caudal of the cord with intact sensation and motor function. Once you've determined the 4 levels I mentioned above, the NLI would be the most cephalad of those. I hope it's all clear now.

Hello Dear Hoda, Sorry for the late reply, for some reason I never got notification of your question. The level was C7 not C8, because remember the rule for motor level: the level itself must be scored 3 or more, and all levels above it must be intact. In this example, the motor level on the left can't be C8 because C8 itself is scored 2. That is why the motor level on the left is C7. I hope it's clear now 🙂

Hello again, Can you please clarify your question? What part are you talking about?

for sensory, we take the level above the altered sensation for motor, we take the lowest level with grades 3,4, or 5

Hello again, sorry for the late reply, I got the notification of your comment only today. The idea in both sensory and motor levels is that we choose the most caudal segment with what we consider "intact" function. For sensory, by definition "intact" is 2 on LT and 2 on PP. For motor, "intact" is one that has grade of 3 or more. 3 was considered normal because it has sufficient innervation to move against gravity. So, with that, motor level has to have grade of 3 or more provided that all levels above it are absolutely not injured as well. I hope this makes it clear now.

Hoda, it's because C8 on the right fulfils the condition for the motor level: 1. It is the level that has a score of greater than or equal to 3 (its score is 3) 2. All key muscles above it are intact (either 5 if we have motor test (C5 and C6 and C7) and 2 if we do not have motor test (C2 and C3 and C4)) I hope it's clear now 👍

أهلا مرتضى، شكرًا لك على ملاحظتك. فعلًا أنا معك في أهمية استخدام اللغة العربية ولكني مع الأسف اضطررت لاستخدام اللغة الانجليزية كونها لغة التدريس في جامعتي وحتى يكون المحتوى أقرب للمرجع المستخدم لطلابي. أما بالنسبة للصوت، فأيضًا أؤيدك، صراحة حاولت استخدام مايكروفون كون الكمامة تسبب انخفاضًا ملحوظًا في الصوت ولكن واجهتني مشاكل تقنية عديدة وكان هذا التسجيل أفضل ما تمكنت من الوصول له. من ملاحظات طلابي فهمت أن الصوت يكون أفضل لو استمعت للمحتوى عبر سماعة في الأذن. شكرًا لمرورك وان شاء الله يكون القادم أفضل