ASIA SCORE for Spine Injury

The motor score is based on the examination of 10 key-muscles on each side (table I). For each movement, force is measured and assigned a coefficient from 0 (absence of muscle contraction) to 5 when contraction creates a movement in all the joint amplitude against a complete resistance. The maximal total score is so 100 (50 on the Right and 50 on the Left).
Flexion of the elbow Extension of the wrist C5 Flexion of the hip C6 Extension of the knee L2 L3

Extension of the elbow C7 dorsal Flexion of the foot L4 Flexion of P3 3rd finger C8 Extension of the big toe Abduction of 5th finger T1 Plantar Flexion L5 S1

10 key-movements of the ASIA score and corresponding metameric level.

The sensory score is established after studying tact and prick sensitivity on a key point in each of 28 dermatomes on each side. Absence of sensitivity is quoted: 0, the hypo or the hyperesthesia : 1 and normal sensitivity : 2. It is preferable to begin the examination by testing the light touch and the lower part of the body.

2. SF-36 FORM for evaluation of functional statue 3. Mini Mental test 4. Acute spinal cord injury - Frankel Classification Grading System
Grade A Complete neurological injury - no motor or sensory function clinically detected below the level of the injury. Preserved sensation only - no motor function clinically detected below the level of the injury; sensory function remains below the level of the injurybut may include only partial function (sacral sparing qualifies as preserved sensation). Preserved motor non-functional - some motor function observed below the level of the injury, but is of no practical use to the patient. Preserved motor function - useful motor function below the level of the injury; patient can move lower limbs and walk with or without aid, but does not have a normal gait or strength in all motor groups. Normal motor - no clinically detected abnormality in motor or sensory function with normal sphincter function; abnormal reflexes and subjective sensory abnormalities may be present.

Grade B

Grade C

Grade D

Grade E

5. Nurick's classification system for myelopathy on the basis of gait abnormalities

Grade 0 I II III IV Root signs Yes Yes Yes Yes Yes Cord involvement No Yes Yes Yes Yes Gait Normal Normal Mild abnormality Severe abnormality Only with assistance Employment Possible Possible Possible Impossible Impossible

Nurick S. The pathogenesis of spinal cord disorder associated with cervical spondylosis. Brain 1972; 95: 87-100

6. Assessment of treatments for low-back pain (JOA score)

Signs & Symptoms Subjective Symptoms Low-back pain None Occasional Frequent mild or occasional severe pain Frequent or continuous severe pain Score

3 2 1 0

Leg pain & tingling None Occasional slight or occasional severe symptom Frequent slight or occasional severe symptom Frequent or continuous severe symptom 3 2 1 0

Gait Normal Able to walk farther than 500 m, although it results in Pain, tingling, &/or muscle weakness Unable to walk farther than 500 m because of leg pain, Tingling, &/or muscle weakness Unable to walk farther than 100 m because of leg pain, Tingling, &/or muscle weakness 3 2 1 0

Clinical signs Straight legraising test Normal 3070 <30 Sensory disturbance Normal Slight disturbance Marked disturbance 2 1 0 2 1 0

Motor disturbance (manual motor test) Normal (grade 5) Slight weakness (grade 4) Marked weakness (grade 3-0) 2 1 0

Restriction of activities of daily living* Severe Moderate None 2 1 0

Urinary bladder function Normal Mild dysuria Severe dysuria 0 3 6

* Categories measured consisted of the following: turning over while lying down; standing; washing; leaning forward; sitting (~1 hour); lifting or holding heavy objects and walking

7. OSWESTRY PAIN QUESTIONNAIRE

This questionnaire is designed to enable us to understand how much your pain has affected your ability to manage everyday activities. Please answer each Section by circling the ONE CHOICE that most applies to you. We realize that you may feel that more than one statement may relate to you, but Please just circle the one choice which closely describes your problem right now. SECTION 1--Pain Intensity A. The pain comes and goes and is very mild. B. The pain is mild and does not vary much. C. The pain comes and goes and is moderate. D. The pain is moderate and does not vary much. E. The pain is severe but comes and goes. F. The pain is severe and does not vary much. SECTION 2--Personal Care A. I would not have to change my way of washing or dressing inorder to avoid pain. B. I do not normally change my way of washing or dressing eventhough it causes some pain. C. Washing and dressing increase the pain, but I manage not tochange my way of doing it. D. Washing and dressing increase the pain and I it necessary tochange my way of doing it. E. Because of the pain, I am unable to do any washing anddressing without help. F. Because of the pain, I am unable to do any washing ordressing without help.

SECTION 3--Lifting A. I can lift heavy weights without extra pain. B. I can lift heavy weights, but it causes extra pain. C. Pain prevents me from lifting heavy weights off the floor. D. Pain prevents me from lifting heavy weights off the floor, butI can manage if they are conveniently positioned, e.g. on the table. E. Pain prevents me from lifting heavy weights , but I can manage light to medium weights if they are conveniently positioned. F. I can only lift very light weights, at the most. SECTION 4 --Walking A. Pain does not prevent me from walking any distance. B. Pain prevents me from walking more than one mile. C. Pain prevents me from walking more than one mile. D. Pain prevents me from walking more than 1/2 mile. E. I can only walk while using a cane or on crutches. F. I am in bed most of the time and have to crawl to the toilet. SECTION 5--Sitting A. I can sit in any chair as long as I like without pain. B. I can only sit in my favorite chair as long as I like. C. Pain prevents me from sitting more than one hour. D. Pain prevents me from sitting more than 1/2 hour. E. Pain prevents me from sitting more than ten minutes. F. Pain prevents me from sitting at all. SECTION 6 -- Standing A. I can stand as long as I want without pain B. I have some pain while standing, but it does not increase withtime. C. I cannot stand for longer than one hour without increasingpain. D. I cannot stand for longer than hour without increasing pain. E. I cant stand for more than 10 minutes without increasingpain. F. I avoid standing because it increases pain right away. SECTION 7--Sleeping A. I get no pain in bed. B. I get pain in bed, but it does not prevent me from sleeping. C. Because of pain , my normal nights sleep is reduced by lessthan one-quarter. D. Because of pain, my normal nights sleep is reduced by lessthan one-half. E. Because of pain, my normal nights sleep is reduced by lessthan three-quarters. F. Pain prevents me from sleeping at all. SECTION 8--Social Life A. My social life is normal and gives me no pain. B. My social life is normal, but increases the degree of my pain. C. Pain has no significant effect on my social life apart fromlimiting my more energetic interests, e.g., dancing, etc. D. Pain has restricted my social life and I do not go out veryoften. E. Pain has restricted my social life to my home. F. Pain prevents me from sleeping at all.

SECTION 9--Traveling A. I get no pain while traveling. B. I get some pain while traveling, but none of my usual forms oftravel make it any worse. C. I get extra pain while traveling, but it does not compel me toseek alternative forms of travel. D. I get extra pain while traveling which compels me to seekalternative forms of travel. E. Pain restricts all forms off travel. F. Pain prevents all forms of travel except that done lying down. SECTION 10--Changing Degree of Pain A. My pain is rapidly getting better. B. My pain fluctuates, but overall is definitely getting better. C. My pain seems to be getting better, but improvement is slowat present. D. My pain is neither getting better nor worse. E. My pain is gradually worsening. F. My pain is rapidly worsening.

8. Fischer grading for subarachnoid hemorrhage:

The Fisher grading system is used to predict cerebral vasospasm after SAH, as follows:
Grade I Grade II Grade III Grade IV : : : : No subarachnoid blood seen on CT scan Diffuse or vertical layers of SAH less than 1 mm thick Diffuse clot and/or vertical layer greater than 1 mm thick Intracerebral or intraventricular clot with diffuse or no subarachnoid blood

9. Hunt & Hess Grading:

Grade 0 - Unruptured aneurysm Grade 1 - Asymptomatic or mild headache and slight nuchal rigidity Grade 1a - Fixed neurological deficit without acute meningeal/brain reaction Grade 2 - Cranial nerve palsy, moderate to severe headache, nuchal rigidity Grade 3 - Mild focal deficit, lethargy, or confusion Grade 4 - Stupor, moderate to severe hemiparesis, early decerebrate rigidity Grade 5 - Deep coma, decerebrate rigidity, moribund appearance

10. WFNS(World Federation of Neurosurgical Society) Grading in cases with SAH:

Grade I Grade II Grade III Grade IV Grade V : GCS 15, no motor deficit : GCS 13 to 14, no motor deficit : GCS 13 to 14, with motor deficit : GCS 7 to 12, with or without motor deficit : GCS 3 to 6, with or without motor deficit

11. Spetzler-Martin AVM grading system: allocates points for various features to give a score between 0 and 5. Grade 6 is used to describe inoperable lesions. The score correlates with operative outcome.
(Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations. J Neurosurg 1986;65:476-83).

The grading system Size of Nidus

o o o

small (<3cm) = 1 medium (3-6cm) = 2 large (>6cm) = 3

Eloquence of adjacent brain

o o

non-eloquent = 0 eloquent = 1

Venous drainage
o o

superficial only = 0 deep = 1

12. The Karnofsky Performance Scale Index allows patients to be classified as to their functional impairment. This can be used to compare effectiveness of different therapies and to assess the prognosis in individual patients. The lower the Karnofsky score, the worse the survival for most serious illnesses.

KARNOFSKY PERFORMANCE STATUS SCALE DEFINITIONS RATING (%) CRITERIA

100 Able to carry on normal activity and to work; no special care needed. 90 Normal no complaints; no evidence of disease. Able to carry on normal activity; minor signs or symptoms of disease. Normal activity with effort; some signs or symptoms of disease. Cares for self; unable to carry on normal activity or to do active work. Requires occasional assistance, but is able to care for most of his personal needs. Requires considerable assistance and frequent medical care. Disabled; requires special care and assistance. Severely disabled; hospital admission is indicated although death not imminent. Very sick; hospital admission necessary; active supportive treatment necessary. Moribund; fatal processes progressing rapidly. Dead

80

70 Unable to work; able to live at home and care for most personal needs; varying amount of assistance needed.

60

50 40 30

Unable to care for self; requires equivalent of institutional or hospital care; disease may be progressing rapidly.

20 10 0

13. Glasgow Coma Score The GCS is scored between 3 and 15, 3 being the worst, and 15 the best. It is composed of three parameters : Best Eye Response, Best Verbal Response, Best Motor Response, as given below : Best Eye Response. (4) 1. 2. 3. 4. No eye opening. Eye opening to pain. Eye opening to verbal command. Eyes open spontaneously.

Best Verbal Response. (5) 1. 2. 3. 4. 5. No verbal response Incomprehensible sounds. Inappropriate words. Confused Orientated

Best Motor Response. (6) 1. 2. 3. 4. 5. 6. No motor response. Extension to pain. Flexion to pain. Withdrawal from pain. Localizing pain. Obeys Commands.

Note that the phrase 'GCS of 11' is essentially meaningless, and it is important to break the figure down into its components, such as E3V3M5 = GCS 11. A Coma Score of 13 or higher correlates with a mild brain injury, 9 to 12 is a moderate injury and 8 or less a severe brain injury.
Teasdale G., Jennett B., LANCET (ii) 81-83, 1974.

14. CHILDREN'S COMA SCORE

The Children's Coma Score can be used to evaluate the level of consciousness in young children for whom the Glasgow Coma Score may be inappropriate. This can help diagnose and monitor young children may have a decreased level of consciousness following head injury or from other causes. The authors are from Children's Memorial Hospital and Northwestern University in Chicago. Patient selection: young children 1 to 36 months of age Parameters: 1) ocular response 2) verbal response 3) motor response
Parameter Ocular response Finding Pursuit Extra-ocular muscles intact AND pupils reactive Extra-ocular muscles impaired OR pupils fixed Extra-ocular muscles paralyzed AND pupils fixed Cries Spontaneous respirations Apneic Flexes and extends Withdraws from painful stimuli Hypertonic Flaccid Points 4 3 2 1 3 2 1 4 3 2 1

Verbal response Motor response

Total Score = SUM (points for all 3 parameters) Interpretation: Minimum score: 3 Maximum score: 11 The higher the score the better the level of consciousness.
Children's Coma Score 11 8, 9 or 10 3 to 7 Comparable Glasgow Coma Score 9 to 15 5 to 8 3 or 4

Raimondi AJ, Hirschauer J. Head injury in the infant and toddler. Coma scoring and outcome scale. Child's Brain. 1984; 11: 12-35.

15. GOS Rating Form Score:

DEAD

VEGETATIVE STATE Unable to interact with environment; unresponsive

SEVERE DISABILITY Able to follow commands/ unable to live independently

MODERATE DISABILITY Able to live independently; unable to return to work or school

GOOD RECOVERY Able to return to work or school

16. Visual Analogue Scale (VAS) Score: A simple assessment tool consisting of a 10 cm line with 0 on one end, representing no pain, and 10 on the other, representing the worst pain ever experienced which a patient marks to indicate severity of his or her pain.