Dear Mrs. Tayseer, great presentation. Just one small comment: For an AIS grade D, at least half (half or more) of the key muscles below the NLI need to have a strength >= 3/5. The AIS is an optimistic grading scale 🙂 Rüdiger Rupp Chair of the ASIA Int'l Standards Committee
Dear Rüdiger Rupp, Thank you so much for the clarification... I'm sorry I missed this piece... And thanks for stopping by my channel, I prepared those videos for my students during Covid-19 lockdown, will definitely work on improving content in the future
This is very helpful Dr. Maha. It gave me a good visual learning. Please read my two comments below, and let me know what you think. I have been thinking about this for a while.
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 👍
Thank you so much for making this video. I just want to clarify that zone of partial preservation is applicable ONLY IF SCI is ASIA A (complete injury). Hence, zone of partial preservation for ASIA B, C, D, E is not applicable.
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.
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.
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.
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 🙂
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
Good day I believe your grading is mistaken on a couple of things. Sensory level is determined by the level that is grade 2 bilaterally so it should be C8. Motor level is the same but with motor function bilaterally so it should be C7. Lastly, NLI is the most caudal level..not cephalic as you said in the video but it is C7
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.
![Classifying Spinal Cord Injuries using ASIA Scoring [Explanation + Example 1]](http://i.ytimg.com/vi/LErgPVcgHW0/mqdefault.jpg)
![Classifying Spinal Cord Injuries using ASIA Scoring [Explanation + Example 1]](/img/tr.png)
Dear Mrs. Tayseer,
great presentation. Just one small comment: For an AIS grade D, at least half (half or more) of the key muscles below the NLI need to have a strength >= 3/5. The AIS is an optimistic grading scale 🙂
Rüdiger Rupp
Chair of the ASIA Int'l Standards Committee
Dear Rüdiger Rupp,
Thank you so much for the clarification... I'm sorry I missed this piece...
And thanks for stopping by my channel, I prepared those videos for my students during Covid-19 lockdown, will definitely work on improving content in the future
Thanks a lot Dr. Maha , God bless you.
this video helps me a lot, thank you very much prof
More than welcome Duy
This is very helpful Dr. Maha. It gave me a good visual learning. Please read my two comments below, and let me know what you think. I have been thinking about this for a while.
Thank you Elman. Your questions are answered below.
Doctor maha why did we say that motor level on rt side is c8 ?
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 👍
Thank you so much for making this video. I just want to clarify that zone of partial preservation is applicable ONLY IF SCI is ASIA A (complete injury). Hence, zone of partial preservation for ASIA B, C, D, E is not applicable.
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 👍
very helpful, thank you
Thank you 🙂
Doctor maha
Why did we choose the highest score for sensory
And lowest score for the motor
In upper limb
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.
Shouldnt neurological level for right side motor be L4 instead of c8
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
Thank you
Why did was in second example
Motor level on lt side was c7
I thought it would be c8
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 🙂
Thank youuu sooo much
How do we determine if this is asia c ?
4 is d
5555 is e
3 2 2 2 3 3 3 is c ?
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
Great
Thank you so much 🙂
Good day I believe your grading is mistaken on a couple of things. Sensory level is determined by the level that is grade 2 bilaterally so it should be C8. Motor level is the same but with motor function bilaterally so it should be C7. Lastly, NLI is the most caudal level..not cephalic as you said in the video but it is C7
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.
Thank you