60-Day Reevaluation

ASIA exams are onerous, and I often find them frustrating. I've been through two of them in the past week.  

I had my 60-day reevaluation with Dr. Becker, the doctor overseeing my case at the ICSCI, on Tuesday, October 7.  Part of the evaluation was an ASIA exam, which would quantify any changes in my level of sensory/motor function since beginning therapy.

The ASIA exam consists of three parts. The first two test for tactile perception of light touch and pain at each of 28 key sensory points, each correlating to a different level of the spinal cord (C-2 through S-4/5).

The doctor or therapist administering the examination begins by lightly touching an area of uncompromised sensory perception (the face/cheek) with a cotton swab, to demonstrate “normal” sensation – the sensation with which all test sensations are compared during the exam.  Then, the exam begins at C-2.  The examiner touches each of the key points, on both the left and right sides, with the cotton swab, and asks the patient whether he/she is able to feel it.

The pain test is conducted using the same method, but the implement used to induce sensation is a pin, rather than a cotton swab.  The pin stick doesn’t really hurt, but ability to perceive the sharpness does determine whether there is viable pain sensation at a particular point. 

I lay on the exam table with my eyes closed (so I can’t see when/where the sensory input is being administered).  Dr. Becker touches the end of the pin to my face; I feel the sharp point on my skin and see a tiny white dot appear and fade into the blackness behind my closed eyelids.  

“Does that feel normal?” 

“Yes,” I say.

He repeats the test on left side of my neck …  

“That?”  

“Yes.”  

… on my clavicle…

“That?”  

“Yes.”  

… on my shoulder…

“That?”

“Yes.”

… on my chest…

“That?”

“Yes.”

… on my arm, just above the elbow…

“That?”

“Um… sort of?  I felt the pressure, but it’s impaired.”

Then his voice comes from what sounds like the vicinity of my hand…

“That?”

But, I haven’t felt the stick, haven’t seen the brief spark of white pierce the darkness behind my eyelids.

“Um… no.”

“That?” he asks a few more times, but his voice is the only sensory input pervading the darkness.  “No,” I respond to each.  There is nothing.

It’s at about this point of the ASIA exam that I usually become a little frustrated.  Testing beyond my known functional level has always seemed rather perfunctory to me.  I mean, it’s not as if I’m suddenly going to feel something in the lower 85 percent of my body where I haven’t felt anything for 17 years…

A fleeting twinge on the inside of my upper arm.  “That?”

“Um… yes?”  

I’m fairly sure that wasn’t there before.  

Looks like I’ll have to rethink that ‘perfunctory’ theory.