DOCSLIB.ORG

International Standards for Neurological Classification of Spinal Cord Injury (Revised 2011)

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
International Standards for Neurological Classification of Spinal Cord Injury (Revised 2011) International standards for neurological classification of spinal cord injury (Revised 2011) Steven C. Kirshblum1,2, Stephen P. Burns3, Fin Biering-Sorensen4, William Donovan5, Daniel E. Graves6, Amitabh Jha7, Mark Johansen7, Linda Jones8, Andrei Krassioukov9, M.J. Mulcahey10, Mary Schmidt-Read11, William Waring12 The authors are the members of the International Standards Committee of ASIA. 1UMDNJ/New Jersey Medical School, 2Kessler Institute for Rehabilitation, 3University of Washington School of Medicine, Seattle, Washington, 4Clinic for Spinal Cord Injuries, Rigshospitalet, and Faculty of Health Sciences, University of Copenhagen, Denmark, 5University of Texas, Houston, Texas, 6University of Kentucky, 7Craig Hospital, Englewood, CO, 8Geron Corporation, Menlo Park, CA, USA, 9International Collaboration on Repair Discoveries, Vancouver, British Columbia, Canada, 10Shriners Hospital for Children, 11Magee Rehabilitation Hospital, Philadelphia, PA, 12Medical College of Wisconsin, Milwaukee, Wisconsin Introduction above which they exit (i.e. C1 exits above the C1 vertebra, This article represents the content of the booklet, just below the skull and C6 nerve roots pass between the International Standards for Neurological Classification C5 and C6 vertebrae) whereas C8 exists between the C7 of Spinal Cord Injury, revised 2011, published by the and T1 vertebra; as there is no C8 vertebra. The C1 American Spinal Injury Association (ASIA). For further nerve root does not have a sensory component that is explanation of the clarifications and changes in this tested on the International Standards Examination. revision, see the accompanying article (Kirshblum S., The thoracic spine has 12 distinct nerve roots and the et al. J Spinal Cord Med. 2011:DOI 10.1179/ lumbar spine consists of 5 distinct nerve roots that are 107902611X13186000420242 each named accordingly as they exit below the level of the The spinal cord is the major conduit through which respective vertebrae. The sacrum consists of 5 embryonic motor and sensory information travels between the brain sections that have fused into one bony structure with 5 dis- and body. The spinal cord contains longitudinally oriented tinct nerve roots that exit via the sacral foramina. The spinal spinal tracts (white matter) surrounding central areas (gray cord itself ends at approximately the L1-2 vertebral level. matter) where most spinal neuronal cell bodies are located. The distal most part of the spinal cord is called the conus The gray matter is organized into segments comprising medullaris. The cauda equina is a cluster of paired (right sensory and motor neurons. Axons from spinal and left) lumbosacral nerve roots that originate in the sensory neurons enter and axons from motor neurons region of the conus medullaris and travel down through leave the spinal cord via segmental nerves or roots. the thecal sac and exit via the intervertebral foramen In the cervical spine, there are 8 nerve roots. Cervical below their respective vertebral levels. There may be 0, roots of C1-C7 are named according to the vertebra 1, or 2 coccygeal nerves but they do not have a role with the International Standards examination in accord- Correspondence to: Steven Kirshblum MD., Kessler Institute for ance with the International Standards for Neurological Rehabilitation, 1199 Pleasant Valley Way, West Orange, NJ 07052. Email: [email protected] Classification of Spinal Cord Injury (ISNCSCI). Copyright 2011 American Spinal Injury Association. This reprint is intended for the express use of training professionals in the use of the International Standards for Neurological Classification of Spinal Cord Injury. No part of this publication may be modified, reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, photocopying, recording or otherwise, without written permission of ASIA. All rights reserved. Adopted and reprinted with permission. The only portion of this reprint to which this prohibition of modification, reproduction, storage in a retrieval system or transmission in any form does not apply is the “Standard Neurological Classification of Spinal Cord Injury” worksheet. Notice at the bottom of that page attests to the permission granted by ASIA for duplication, but alteration of this form in any manner is prohibited without permission from ASIA. © The Academy of Spinal Cord Injury Professionals, Inc. 2011 DOI 10.1179/204577211X13207446293695 The Journal of Spinal Cord Medicine 2011 VOL. 34 NO. 6 535 Kirshblum et al. International standards for neurological classification of spinal cord injury Each root receives sensory information from skin legs and pelvic organs may be involved. The term is areas called dermatomes. Similarly each root innervates used in referring to cauda equina and conus medullaris a group of muscles called a myotome. While a derma- injuries, but not to lumbosacral plexus lesions or injury tome usually represents a discrete and contiguous skin to peripheral nerves outside the neural canal. area, most roots innervate more than one muscle, and Tetraparesis and paraparesis: Use of these terms is dis- most muscles are innervated by more than one root. couraged, as they describe incomplete lesions impre- Spinal cord injury (SCI) affects conduction of sensory cisely, and incorrectly implies that tetraplegia and and motor signals across the site(s) of lesion(s), as well paraplegia should only be used for neurologically com- as the autonomic nervous system. By systematically plete injuries. Instead, the ASIA Impairment Scale examining the dermatomes and myotomes, as described (AIS) provides a more precise approach to description within this booklet, one can determine the cord segments of severity (i.e. completeness) of the SCI. affected by the SCI. From the International Standards Dermatome: This term refers to the area of the skin examination several measures of neurological damage innervated by the sensory axons within each segmental are generated, e.g., Sensory and Motor Levels (on right nerve (root). and left sides), NLI, Sensory Scores (Pin Prick and Myotome: This term refers to the collection of muscle Light Touch), Motor Scores (upper and lower limb), fibers innervated by the motor axons within each seg- and ZPP. This booklet also describes the ASIA mental nerve (root). (American Spinal Injury Association) Impairment Sensory level: The sensory level is determined by per- Scale (AIS) to classify the severity (i.e. completeness) of forming an examination of the key sensory points within injury. each of the 28 dermatomes on each side of the body This booklet begins with basic definitions of common (right and left) and is the most caudal, normally inner- terms used herein. The section that follows describes the vated dermatome for both pin prick (sharp/dull dis- recommended International Standards examination, crimination) and light touch sensation. This may be including both sensory and motor components. different for the right and left side of the body. Subsequent sections cover sensory and motor scores, Motor level: The motor level is determined by exam- the AIS classification, and clinical syndromes ining a key muscle function within each of 10 myotomes associated with SCI. For ease of reference, a worksheet on each side of the body and is defined by the lowest key (Appendix 1) of the recommended examination is muscle function that has a grade of at least 3 [on manual included, with a summary of steps used to classify the muscle testing (MMT) in the supine position], providing injury (Appendix 2). A full-size version for photocopy- the key muscle functions represented by segments above ing and use in patient records has been included as an that level are judged to be intact (graded as a 5 on enclosure and may also be downloaded from the ASIA MMT). This may be different for the right and left website (www.asia-spinalinjury.org). Additional details side of the body. regarding the examination and e-Learning training Neurological level of injury (NLI): The NLI refers to materials can also be obtained from the website15. the most caudal segment of the spinal cord with normal sensory and antigravity motor function on Definitions both sides of the body, provided that there is normal Tetraplegia (preferred to “quadriplegia”): This term (intact) sensory and motor function rostrally. The seg- refers to impairment or loss of motor and/or sensory ments at which normal function is found often differ function in the cervical segments of the spinal cord by side of the body and in terms of sensory and motor due to damage of neural elements within the spinal testing. Thus, up to four different segments may be canal. Tetraplegia results in impairment of function in identified in determining the neurological level, i.e., the arms as well as typically in the trunk, legs and R(ight)-sensory, L(eft)-sensory, R-motor, L-motor. pelvic organs, i.e. including the four extremities. It The single NLI is the most rostral of these levels. does not include brachial plexus lesions or injury to per- Skeletal level: This term has been used to denote the ipheral nerves outside the neural canal. level at which, by radiographic examination, the greatest Paraplegia: This term refers to impairment or loss of vertebral damage is found. The skeletal level is not part motor and/or sensory function in the thoracic, lumbar of the current ISNCSCI because not all cases of SCI or sacral (but not cervical) segments of the spinal cord, have a bony injury, bony injuries do not consistently cor- secondary to damage of neural elements within the relate with the neurological injury to the spinal cord, spinal canal. With paraplegia, arm functioning is and this term cannot be revised to document neurologi- spared, but, depending on the level of injury, the trunk, cal improvement or deterioration. 536 The Journal of Spinal Cord Medicine 2011 VOL. 34 NO. 6 Kirshblum et al. International standards for neurological classification of spinal cord injury Sensory scores (see worksheet; Appendix 1): This term with minimal equipment (safety pin and cotton wisp) refers to a numerical summary score of sensory function.
Load more

Recommended publications
  • 15-1117 ) Issued: July 6, 2016 U.S
    United States Department of Labor Employees’ Compensation Appeals Board __________________________________________ ) T.T., Appellant ) ) and ) Docket No. 15-1117 ) Issued: July 6, 2016 U.S. POSTAL SERVICE, POST OFFICE, ) Philadelphia, PA, Employer ) __________________________________________ ) Appearances: Case Submitted on the Record Michael D. Overman, Esq., for the appellant Office of Solicitor, for the Director DECISION AND ORDER Before: CHRISTOPHER J. GODFREY, Chief Judge PATRICIA H. FITZGERALD, Deputy Chief Judge COLLEEN DUFFY KIKO, Judge JURISDICTION On April 21, 2015 appellant, through counsel, filed a timely appeal of a December 9, 2014 merit decision of the Office of Workers’ Compensation Programs (OWCP). Pursuant to the Federal Employees’ Compensation Act1 (FECA) and 20 C.F.R. §§ 501.2(c)(1) and 501.3, the Board has jurisdiction to consider the merits of the case. ISSUE The issue is whether appellant has met her burden of proof to establish either cervical radiculopathy or a brachial plexus injury, causally related to factors of her federal employment. On appeal counsel alleges that the impartial medical specialist failed to provide sufficient medical reasoning to resolve the existing conflict of medical opinion evidence. 1 5 U.S.C. § 8101 et seq. FACTUAL HISTORY This case has previously been on appeal before the Board.2 The facts and the circumstances outlined in the Board’s prior decision are incorporated herein by reference. The facts relevant to this appeal are set forth below. On March 20, 2008 appellant, then a 44-year-old distribution clerk, filed a timely occupational disease claim (Form CA-2), alleging that she developed neck and shoulder conditions due to repetitive work tasks, commencing June 1, 2006.
    [Show full text]
  • Brachial-Plexopathy.Pdf
    Brachial Plexopathy, an overview Learning Objectives: The brachial plexus is the network of nerves that originate from cervical and upper thoracic nerve roots and eventually terminate as the named nerves that innervate the muscles and skin of the arm. Brachial plexopathies are not common in most practices, but a detailed knowledge of this plexus is important for distinguishing between brachial plexopathies, radiculopathies and mononeuropathies. It is impossible to write a paper on brachial plexopathies without addressing cervical radiculopathies and root avulsions as well. In this paper will review brachial plexus anatomy, clinical features of brachial plexopathies, differential diagnosis, specific nerve conduction techniques, appropriate protocols and case studies. The reader will gain insight to this uncommon nerve problem as well as the importance of the nerve conduction studies used to confirm the diagnosis of plexopathies. Anatomy of the Brachial Plexus: To assess the brachial plexus by localizing the lesion at the correct level, as well as the severity of the injury requires knowledge of the anatomy. An injury involves any condition that impairs the function of the brachial plexus. The plexus is derived of five roots, three trunks, two divisions, three cords, and five branches/nerves. Spinal roots join to form the spinal nerve. There are dorsal and ventral roots that emerge and carry motor and sensory fibers. Motor (efferent) carries messages from the brain and spinal cord to the peripheral nerves. This Dorsal Root Sensory (afferent) carries messages from the peripheral to the Ganglion is why spinal cord or both. A small ganglion containing cell bodies of sensory NCS’s sensory fibers lies on each posterior root.
    [Show full text]
  • Central Adaptation Following Brachial Plexus Injury
    UCSF UC San Francisco Previously Published Works Title Central Adaptation following Brachial Plexus Injury. Permalink https://escholarship.org/uc/item/2ds5z53m Authors Simon, Neil G Franz, Colin K Gupta, Nalin et al. Publication Date 2016 DOI 10.1016/j.wneu.2015.09.027 Peer reviewed eScholarship.org Powered by the California Digital Library University of California Literature Reviews Central Adaptation following Brachial Plexus Injury Neil G. Simon1, Colin K. Franz2,3, Nalin Gupta4, Tord Alden5,6, Michel Kliot6 Key words Brachial plexus trauma (BPT) often affects young patients and may result in - Apraxia lasting functional deficits. Standard care following BPT involves monitoring for - Brachial plexus injury - Central adaptation clinical and electrophysiological evidence of muscle reinnervation, with sur- - Nerve trauma gical treatment decisions based on the presence or absence of spontaneous - Neuroplasticity recovery. Data are emerging to suggest that central and peripheral adaptation may play a role in recovery following BPT. The present review highlights Abbreviations and Acronyms BPT: Brachial plexus trauma adaptive and maladaptive mechanisms of central and peripheral nervous system CIMT: Constraint-induced movement therapy changes following BPT that may contribute to functional outcomes. Rehabili- CNS: Central nervous system tation and other treatment strategies that harness or modulate these intrinsic EMG: Electromyography adaptive mechanisms may improve functional outcomes following BPT. ES: Electrical stimulation H-reflex: Hoffman reflex MRI: Magnetic resonance imaging OBPP: Obstetric brachial plexus palsy PNI: Peripheral nerve injury RECOVERY FROM BPT functional recovery, with no residual def- fi Recovery of nerve tracts following BPT icits identi ed on serial clinician or phys- 1St. Vincent’s Clinical School, University of New South 1 2 relies on a complex cascade of peripheral iotherapist review.
    [Show full text]
  • Brachial Plexus Injury
    Brachial Plexus Injury The brachial plexus (BRAY key el PLEK sis) is a group of nerves that starts in the spinal cord at the neck and controls the hand, wrist, elbow and shoulder. The nerves signal these parts of the body to move and to feel (Picture 1). What causes brachial plexus injury In most cases an injury happens to the baby during birth. It can happen for several reasons. The main cause is the birth of a large baby through a small birth passage (Picture 2). Also, if the baby has trouble breathing or is in a hard birth position, the doctor may have to use tools to help deliver the baby. In any of these cases, a brachial plexus injury may occur if the neck and shoulder of the baby is stretched in the delivery (shoulder dystocia – dis TO se ah). Picture 1 Brachial Plexus An injury to the brachial plexus causes problems with the messages the nerves send to the shoulder, arm or hand on that side of the body. Car accidents, sports injuries or falls may cause brachial plexus injuries in an older child. Picture 2 Brachial plexus injury during birth HH-I-334 9/13, Revised 6/18 | Copyright 2011, Nationwide Children’s Hospital Continued… Symptoms Your child may have all or only some of the following symptoms on the side of the injury: . Limited or no movement in the shoulder, arm and hand . Muscle weakness or a limp arm . Loss of feeling in the shoulder, arm and hand . Drooping eyelid . Constricted (smaller) pupil in the eye .
    [Show full text]
  • Nerve Transfers for Restoration of Finger Flexion in Patients with Tetraplegia
    CLINICAL ARTICLE J Neurosurg Spine 26:55–61, 2017 Nerve transfers for restoration of finger flexion in patients with tetraplegia Jayme A. Bertelli, MD, PhD,1,2 and Marcos F. Ghizoni, MD, MSc2 1Center of Biological and Health Sciences, Department of Neurosurgery, University of the South of Santa Catarina (Unisul), Tubarão; and 2Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina, Brazil OBJECTIVE The purpose of this paper was to report the authors’ results with finger flexion restoration by nerve transfer in patients with tetraplegia. METHOds Surgery was performed for restoration of finger flexion in 17 upper limbs of 9 patients (8 male and 1 female) at a mean of 7.6 months (SD 4 months) after cervical spinal cord injury. The patients’ mean age at the time of surgery was 28 years (SD 15 years). The motor level according to the ASIA (American Spinal Injury Association) classification was C-5 in 4 upper limbs, C-6 in 10, and C-7 in 3. In 3 upper limbs, the nerve to the brachialis was transferred to the anterior interosseous nerve (AIN), which was sepa- rated from the median nerve from the antecubital fossa to the midarm. In 5 upper limbs, the nerve to the brachialis was transferred to median nerve motor fascicles innervating finger flexion muscles in the midarm. In 4 upper limbs, the nerve to the brachioradialis was transferred to the AIN. In the remaining 5 upper limbs, the nerve to the extensor carpi radialis brevis (ECRB) was transferred to the AIN. Patients were followed for an average of 16 months (SD 6 months).
    [Show full text]
  • Bilateral Brachial Plexus Injury Fahim Anwar, Danny Mclaughlin and Bhupinder S
    CASE REPORT Bilateral Brachial Plexus Injury Fahim Anwar, Danny McLaughlin and Bhupinder S. Panesar ABSTRACT Brachial plexus injuries can occur as a result of various mechanisms such as stretching, direct and indirect trauma or following childbirth. Bilateral brachial plexus injuries are uncommon and associated with a poor functional outcome. We report a case of bilateral brachial plexus injury resulting from prolonged immobilization of the arms in hyper-abducted position resulting in compression of the brachial plexus on both sides. The injuries were treated conservatively and following 4 months of active rehabilitation in our unit, the patient still had poor arm functions and required care and support in the community on discharge. Key words: Bilateral. Brachial plexus. Injury. Rehabilitation. INTRODUCTION Table I: Summary of neurological findings. Brachial plexus is a network of nerves originating from Medical research council grading of muscle power fifth to seventh cervical (C5-C7) and the first two At admission Following rehabilitation thoracic (T1-T2) spinal nerves. These networks of Right Left Right Left nerves innervate the muscles and skin of the chest, Shoulder abduction 2 1 4 3 Shoulder flexion 0 0 4 3 shoulder, arm and hand. Damage to these nerves Elbow flexion 0 0 0 0 lead to symptoms ranging from a completely paralyzed Elbow extension 0 0 0 0 upper limb to a lack of muscle control in the arm, Wrist flexion 0 0 3 2 wrist or hand and diminished sensations. Injury to the Wrist extension 0 0 0 0 brachial plexus could be the result of trauma to the Finger flexion 1 0 3 2 1 shoulder, traction injury to the spine, inflammation or Finger extension 0 0 0 0 tumour.
    [Show full text]
  • Brachial Plexus Injury Reversing Paralysis & Restoring Function
    The Paralysis Center PATIENT GUIDE Brachial Plexus Injury Reversing Paralysis & Restoring Function Justin M. Brown, M.D. Contents 1. Introduction 2. The Anatomy of a Damaged Nerve 3. Assessing Nerve Damage 4. Understanding Brachial Plexus Anatomy 5. Diagnosing Brachial Plexus Injuries - Nerve Conduction & Diagnostic Studies - Diagnostic Testing 6. Understanding Your Treatment Options - Reconstructive Neurosurgery ● Nerve Grafting ● Tendon Transfer ● Muscle Transplant ● Nerve Transfer 7. Why Nerve Transfers are so Successful in Reversing Many Forms of Paralysis - Nerve Transfer as MVP (Most Valuable Player) 8. Post Operative Rehabilitation - Physical and Occupational Therapy 9. But What About …? - Stem Cell Therapy - Robotic Arm 10. Brachial Plexus Patient Stories - Meet Kyle - Meet Diana and Josh 11. Are You a Candidate for Nerve Reconstruction? 12. Tips to Help You Prepare for Your Initial Consult 13. Conclusion 14. About Dr. Brown 15. Contact The Paralysis Center 1 1. Introduction If you are a patient who has suffered injury to your brachial plexus, we are battling against time. Please do not wait to see what kind of function may or may not return following your injury, no matter what you may have been told. More than any other nerve injury, repairing a brachial plexus injury is the most complex and the most time-sensitive of any peripheral nerve injury. We have the greatest chance of restoring maximum function to your arm and hand the faster you can be seen by a Brachial Plexus Specialist - ideally within the first six months following your injury. If this is you, please book a consult immediately with a Brachial Plexus specialist. In 2017, in partnership with Massachusetts General Hospital, Harvard Medical School, and the Spaulding Rehabilitation Hospital, we founded the Paralysis Center - a world-class patient treatment and medical research center for all forms of paralysis.
    [Show full text]
  • Repairing Spinal Roots After Brachial Plexus Injuries
    Paraplegia (I 995)n. 359-361 © 1995 International Medical Society of Paraplegia All rights reserved 0031.1758/95$12.00 Repairing spinal roots after brachial plexus injuries MA Glasby! and TEl Hems2 1 Department of Anatomy, University of Edinburgh Medical School, Teviot Place, Edinburgh EH8 9AG; 2Nuffield Orthopaedic Centre, Headington, Oxford, UK The problems of repairing spinal roots after brachial plexus avulsion injuries are discussed in the light of current surgical diagnosis and treatment. An advancing understanding of the cellular mechanisms of nerve regeneration and progress in surgical technology indicates a possibility for the repair at least of ventral roots with grafts which may be of neural or non-neural origin. Enhancement of the regenerative properties may further be made possible by the application of neurotrophic factors at the repair site or centrally. The short and long-term implications of current research into these methods are discussed. Keywords: spinal root repair; nerve regeneration; ventral root implantation; neurotrophic factors The present rarely regained in adults but appears to have a slightly better prognosis in young children.4,5 Over 350 patients suffer severe damage from closed traction injuries of the brachial plexus each year in the United Kingdom.1 Many of these are young adults involved in motorcycle accidents.2 Over recent years, The future surgical exploration has been increasingly recom­ mended if the mechanism of injury suggests that a The typical traction injury sustained by any spinal root major disruption is likely and if examination reveals a consists of rupture of all neural elements whilst the complete absence of function of all or any part of the integrity of the fibrous epineurium is maintained plexus.1,3-5 Operation should be carried out as soon as (Sunderland type IV).9 Repair is by excision of the possible after injury.
    [Show full text]
  • American College of Radiology ACR Appropriateness Criteria® Plexopathy
    Revised 2021 American College of Radiology ACR Appropriateness Criteria® Plexopathy Variant 1: Brachial plexopathy, acute or chronic, nontraumatic. No known malignancy. Initial imaging. Procedure Appropriateness Category Relative Radiation Level MRI brachial plexus without IV contrast Usually Appropriate O MRI brachial plexus without and with IV Usually Appropriate O contrast MRI cervical spine without and with IV May Be Appropriate O contrast MRI cervical spine without IV contrast May Be Appropriate O May Be Appropriate CT neck with IV contrast ☢☢☢ US neck Usually Not Appropriate O MRI brachial plexus with IV contrast Usually Not Appropriate O MRI cervical spine with IV contrast Usually Not Appropriate O Usually Not Appropriate CT cervical spine with IV contrast ☢☢☢ CT cervical spine without and with IV Usually Not Appropriate contrast ☢☢☢ Usually Not Appropriate CT cervical spine without IV contrast ☢☢☢ Usually Not Appropriate CT neck without and with IV contrast ☢☢☢ Usually Not Appropriate CT neck without IV contrast ☢☢☢ Usually Not Appropriate CT myelography cervical spine ☢☢☢☢ Usually Not Appropriate FDG-PET/CT whole body ☢☢☢☢ ACR Appropriateness Criteria® 1 Plexopathy Variant 2: Lumbosacral plexopathy, acute or chronic, nontraumatic. No known malignancy. Initial imaging. Procedure Appropriateness Category Relative Radiation Level MRI lumbosacral plexus without and with IV Usually Appropriate O contrast MRI lumbosacral plexus without IV contrast Usually Appropriate O MRI lumbar spine without and with IV May Be Appropriate O contrast
    [Show full text]
  • The International Standards Booklet for Neurological and Functional Classification of Spinal Cord Injury*
    Paraplegia 32 (1994) 70-80 © 1994 International Medical Society of Paraplegia The International Standards Booklet for Neurological and Functional Classification of Spinal Cord Injury* 1 F Ditunno lr MD,! W Young PhD MD,2 W H Donovan MD,3 G Creasey MD-+ 1 Department of Rehabilitation Medicine, Thomas Jefferson University Ho pital � : . Philadelphia, Pennsylvania; 2 Department of eurosurgery, New York Umverslty edlcal 3 ."! . � Center, New York; The Institute for RehabdltatlOn and Research, l!0u�ton, Texas, 4Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA. Introduction recognition of the need for greater accept­ ance, ASIA sought input from a broader For almost a quarter of a century the international community in spinal cord in­ array of experts representing. SCI res�a.rch jury (SCI) has advocated a unifor measure interests as well as from dIverse chlllcal � specialis s. The international Medical Soci­ of SCI severity. 1 Such agreement IS needed � ety of Paraplegia (IMSOP), as ell as ma y for the accurate communication between � � other organizations and professIOnal socie­ clinicians and for comparisons of research ties interested in classification, were repre­ results among investigators. The severity f ? sented by members on the committee the injury after SCI is primarily reflecte� III the extent of paralysis and loss of sensation formed in 1990. The international standards revised by the ASIA Committee in 1992 (impairment) and the inability to perform activities of daily living (disability). These were endorsed by IMSOP in Barcelona, in measurements of impairment and disability September 1992. The rationale for these standards evolved serve as the determinants of the clinical from two major influences.
    [Show full text]
  • Download the Brachial Plexus Center Brochure
    BRACHIAL PLEXUS CENTER DEPARTMENT OF NEUROSURGERY, NEUROLOGY, AND ORTHOPEDIC SURGERY ESTABLISHED IN 1991 EXPERTISE OF THE ST. LOUIS CHILDREN’S BRACHIAL PLEXUS CENTER HOSPITAL • 390 beds • 3,330 employees • 818 medical staff members • 1,300 auxiliary members and volunteers • More than 45 pediatric subspecialty departments and divisions • Level I Pediatric Trauma Center, the highest level of emergency care available Founded in 1879, St. Louis Children’s Left to Right: Tae Sung Park, MD, Nicole Meyer, PA-C, Lindley Wall, MD, Michael Noetzel, MD Hospital is one of the premier • Recognized as one of the best children’s children’s hospitals in the nation. It hospitals in the nation serves not just the children of St. Established in 1991, the Brachial Plexus Center has extensive by U.S. News & Louis, but children across the world. experience in the treatment of birth brachial plexus injury. World Report As the pediatric teaching hospital Our Center has cared for over 1,000 infants with brachial plexus for Washington University School of injury and performed brachial plexus repair procedures on over • Received the nation’s 250 infants. highest honor for Medicine, St. Louis nursing excellence, Children’s Hospital The Center’s team consists of pediatric neurosurgeons, neurologist, the Magnet designation, offers nationally orthopedic surgeon, occupational and physical therapists, from the American recognized neuroradiologist, and clinical coordinator. Nurses Credentialing programs for At the Brachial Plexus Center at St. Louis Children’s Hospital, Center. physician training parents find hope and unparalleled pediatric expertise. and research. 1 2 The Brachial Plexus THE CAUSE OF BIRTH BRACHIAL PLEXUS PALSY The brachial plexus is a complex arrangement of nerves that controls Diagram 3: Shoulder Dystocia the muscles of the shoulder, arms and hands.
    [Show full text]
  • Intraventricular Hemorrhage (IVH)
    Neurological and Neuromuscular Disorders Elizabeth Papp, RN, MSN, CNS June, 2018 Neuromuscular Birth Injuries: Overview • Nerve damage caused by trauma during delivery • Abnormal labor time (long or short) • LGA • CPD • Abnormal presentation • Instrument-assisted delivery • Nerves most commonly implicated • Cervical nerves 5, 6, 7, and 8 • Thoracic nerve 1 • Cranial nerve VII • Phrenic nerve 2 Neuromuscular Birth Injuries: Brachial Plexus Injuries • Presentation – Erb’s palsy: • No spontaneous abduction or external rotation of affected arm (absent Moro) • Hand function is often preserved (grasp reflex present) • “waiter’s tip position” – Global plexus palsy (Erb-Duchenne-Klumpke): • Flaccidity of affected arm and hand • Absent Moro and grasp reflexes – Klumpke palsy: • Flaccidity of hand and fingers of affected arm (present Moro, absent grasp) • “claw-hand deformity” 3 Neuromuscular Birth Injuries: Brachial Plexus Injuries • Cause – Erb’s palsy: • Most common, injury to nerve roots C5 and C6 – Global plexus palsy (Erb-Duchenne- Klumpke): • Second most common, injury to nerve roots C5 through T1 – Klumpke palsy: • Injury to nerve roots C8 and T1 only 4 Neuromuscular Birth Injuries: Brachial Plexus Injuries • Management – Physical examination to assess extent of neurological involvement – X-ray if concern for fracture or shoulder dislocation – Neurology, orthopedic, and PT consultation – Passive ROM exercises when post-injury neuritis has resolved (7-10 days) – Use of wrist and/or finger splints, if indicated – Caregiver education regarding
    [Show full text]