[Music] this is the asia the american spinal institute america association motor exam and sensory exam this is the kind of exam that's carried out and all of the spinal injury patients we can see all the dermatomes and muscle groups outlined in the total scores that you would expect from that and based on that the the there's a franco class of asian impairment scale that that's given a b c and d and sometimes this can be very confusing and it's probably easier just to deal with the beginning and end a is complete that is there is nothing preserved below a certain spinal cord injury there is no sensation preserved there's no motor that's preserved even including the sacral segments the the rectal exam for sentry and motor e is completely normal full strength full sensation everywhere and then in between it gets a little confusing for b and incomplete has sensory but no motor function preserved below the neurologic level this is kind of classic if someone has a high um or mid cervical injury and they might have like a bicep that works or something um but nothing below that and if they have no perirectal sensation um then that is that the sacral elements s4 and s5 then that's complete if they do have sensation it's incomplete so sensory is is preserved and c is incomplete that's motor function preserved below the neurological level with greater than half of muscles having a muscle grade less than three so still a pretty poor exam and d can actually be quite good uh it's a motor function preserved uh below the neurologic level greater than half the muscles have muscle rate greater than three and this can even include something like oh gosh you're like a four out of five in your right wrist and that that's it like a 99 d um on your exam or something like that and so the initial evaluation and the overall recovery not much has really changed over the years um folks who present and this is post resuscitation um recovery uh in an assessment if they're an a and complete on an assessment um really ten percent or less actually eventually recover the ability to ambulate in some some way shape or form and often this is with braces kind of um like those very stiff metal braces on your legs and things like that and the the b incomplete's 33 so that's a huge difference and and it's um it seems like a minor thing um and quite honestly the sensation the periodical sensation the difference between that and an a that's that's really it there's a three-fold increase in the possibility of being able to ambulate over time this is assuming the best of care and seize the incompletes and about 75 ds um given that they're relatively minor uh overall they generally do quite well um and so uh just some some classic landmarks that you guys i'm sure have heard about t4 uh sensory levels about at the nipple the t10 is it the umbilicus hey everyone ryan rad here from neurosurgery neurosurgerytraining.org if you like that video subscribe and donate to keep our content available for medical students across the world