Grade A is a complete injury, with no motor or sensory function preserved in the sacral segment (S4~5); Grade B is an incomplete injury. There is sensory function below the nerve injury level, including the sacral segment (S4~5), but no motor function; Grade C is an incomplete injury, with motor function below the nerve injury level and more than half of the key muscle strength retained <Grade 3; Grade D is an incomplete injury, with motor function below the nerve injury level and at least half of the key muscle strength retained ≥ grade 3; Grade E is normal, with normal sensory and motor functions.

The evaluation of whether the injury is complete is based on the residual function of the lowest sacral segment (S1~5). When the sensory function is residual, the skin at the junction of the anal skin and mucosa reacts when stimulated; when the motor function is residual, the external anal sphincter is detected during digital anal examination. There is voluntary contraction. In complete spinal cord injury, S4~5 has neither sensory nor motor function; in incomplete spinal cord injury, S4~5 has sensory or motor function.

Key sensory points: Acupuncture and light touch scores are common methods for assessing sensory function in clinical rehabilitation.

Deep anal pressure (DAP): If any repeatable pressure sensation is found in the anus, it means that the patient has incomplete sensory function impairment.

Sensory plane determination: determined by normal or intact dermatomes

Key muscle strength examination: Identify the key muscles and the nerve segments they represent in spinal cord injury motor examination

Voluntary Anal Contraction (VAC): If VAC is present, it is considered an incomplete spinal cord injury

Assessment of non-key muscle strength: The diaphragm, deltoid, hip internal muscles, hamstrings and other muscles can be used to determine the status of incomplete sports injuries.

Sports score: The assessment standard uses manual muscle testing (MMT) to measure muscle strength.

Determination of the plane of motion: The plane of motion is determined by examining 10 key muscles on one side of the body. The lowest key muscle with a muscle strength of level 3 or above represents the plane of motion, provided that the key muscles representing its upper segment function normally. The left and right sides of the body can be different, with the highest of the two sides being a single plane of motion.

Mainly the lowest spinal cord segment with normal motor and sensory functions on both sides of the body. The neurological level of spinal cord injury is mainly based on the motor injury level. The T2-L1 segment is relatively special and is usually determined by the sensory injury level. Motor injury level and sensory injury level: According to ASIA and ISCoS, the injury level can be determined accurately and quickly based on the key muscles and key sensory points innervated by the nerve. When determining the level of injury, the key muscle strength must be ≥ grade 3 and the muscle strength above the level must be normal.

Recording of injury planes: During assessment, the motor injury planes and sensory injury planes on both sides of the body should be recorded in detail.

Assessment of neurologic levels when the patient is unable to undergo examination: Sensory and motor scoring and grading should be performed on a later examination.

subtopic

Rehabilitation treatment goals: Maximize the remaining muscle strength, enhance the patient's joint mobility, improve the functional status of defecation and respiratory tract, and reduce pain; prevent the occurrence of bedridden complications such as pressure ulcers and deep vein thrombosis, and improve the patient's living ability and survival quality.

Main methods of rehabilitation

Psychological intervention and out-of-hospital care

electrical stimulation

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