Spinal Cord Injury Tests: ASIA Spinal Assessment

What Is the ASIA Test?

An American Spinal Injury Association (ASIA) exam is the standard test after a spinal cord injury (SCI). Doctors across the U.S. use it to assess the extent of a spinal injury.

This exam helps the doctor to:

• Learn which parts of the body are working normally and which are not.
• Classify the level of your SCI.
• Predict your recovery from the SCI.

The exam is extensive because it covers the whole body.

A doctor trained in doing the ASIA exam will test the strength and sensation of various parts of your body.

Contact the UPMC Rehabilitation Institute

To learn more about stroke rehabilitation or to refer a patient, call 1-877-287-3422.

What to Expect During the ASIA Test

A doctor should do an ASIA exam within 72 hours of an SCI injury.

During the assessment, you lie on a hospital bed.

The exam has three parts: motor, sensory, and anal.

Motor exam

The motor part measures function in 20 key muscles — 5 in each arm and leg.

Your doctor will ask you to contract these various muscles.

Each key muscle corresponds to a level in the spinal cord, for instance:

• Level C5 corresponds to bending the elbow.
• Level L3 corresponds to straightening the knee.

Sensory exam

The sensory exam measures feeling in points in the neck, arms, legs, chest, hands, and feet.

There are two parts of the sensory exam: light touch and pinprick. Your doctor will do these tests separately because they travel in different nerve pathways in the spinal cord.

Light touch

Each spot on your skin corresponds to a level in the spinal cord.

For instance, sensation:

• On the tip of your middle finger corresponds to C7.
• Behind the knee corresponds to S2.

Pinprick

The pinprick pathway travels closer to the motor pathway than the light touch pathway.

That's why regaining sensation in the pinprick pathway can better predict recovery from an SCI.

For example, if you have:

• Normal light touch sensation at the fingertip.

Then you have:

• About a one in 10 chance of getting strength back in the muscles that straighten the elbow.

If there were:

• Normal pinprick sensations at the tip of the finger.

Then you have:

• At least a six in 10 chance of getting strength back to the elbow.

The anal muscle exam

This vital last step in the ASIA exam tests whether you can voluntarily contract the anal muscle.

The very end of the spinal cord sends motor signals to the external anal sphincter. This is the muscle that contracts when you're trying to hold a bowel movement.

The same nerves that control that muscle also send light touch and pinprick signals back to the spinal cord.

The anal exam shows whether the spinal cord is fully severed (a complete injury) or not fully severed (an incomplete injury).

During anal muscle exam, the doctor will:

• Ask if you can feel pinprick and light touch in the anal area.
• Insert a gloved finger into your rectum and ask you to squeeze it.

If you can feel the pinprick and touch, and you can contract the anal muscle, you have an incomplete SCI. This means function below the point of injury is possible.

If you can't contract the anal muscle and cannot feel light touch and pinprick, you have a complete SCI.

Contact the UPMC Rehabilitation Institute

Call 1-877-287-3422 to learn more about our spinal cord injury rehab program or to refer a patient.

Our spinal cord injury rehab experts

• Jessica Berry, MD.
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