More Progress -- Numbers Going UP!

In addition to quantifiable and documented proof that I've had an increase in motor function, Dr. Becker's evaluation report presented evidence of a return in sensory function, as well.

Much like motor function, the ASIA exam also scores sensory function, however, on a different scale. Light touch and pin-prick (pain) sensation are graded, at each of the 28 key sensory points, as follows:

Sensory Grading Scale
0 = absent sensation
1 = impaired sensation
2 = normal sensation

The official ASIA exam form provides guidelines on where key sensory points for each level are located. It also does a nice job of delineating exactly to where the nerve roots of each vertebral level corresponds to the body.

This (right) is what I like to call the ASIAn Man. Perhaps a modern Vitruvian – only illustrating a different standard of measure. Each area on the ASIAn Man is labeled with the vertebral level that determines its sensory function – i.e., C4 is labeled as such because the nerve roots that carry nerve impulses back and forth to that area of the body insert just below the C4 vertebra.

The black dots in each area indicates its key sensory point – i.e., the spot that is tested with the sharp/light stimulus.

The response to each is graded and recorded on a chart, much like the chart used for scoring the motor function of the exam. The maximum score for each side is 56, for a total of 112 possible points. (If you have no neurological damage, you would score 112.)

There are typically two rows to the following chart - one for upper extremities (C-2 to T-8), one for lower extremities (T-9 to S4/5) - but, my second row is all zeros, and that's rather depressing, so we'll stick with the upper extremities. For now. ;)

My initial evaluation exam resulted in these scores:

Sensory exam, pin-prick

05/06/08

	C2	C3	C4	C5	C6	C7	C8	T1	T2	T3	T4	T5	T6	T7	T8
R	2	2	2	0	0	0	0	0	0	0	0	0	0	0	0	6
L	2	2	2	0	0	0	0	0	0	0	0	0	0	0	0	6

That's grade 2, or "normal", sensory function down to C-4. It's fairly typical, as C-4 is my level of injury. So, that's a grand total of 12.

After just over two months in therapy, my exam score was:

Sensory exam, pin-prick

10/07/08

	C2	C3	C4	C5	C6	C7	C8	T1	T2	T3	T4	T5	T6	T7	T8
R	2	2	2	0	0	0	0	0	0	0	0	0	0	0	0
L	2	2	2	0	0	0	0	1	0	0	0	0	0	0	0

Another lonely 1 in the left column, surrounded by zeros. I am, however, undaunted by what might appear to be a negligible development because the promising part is not so much in the number itself, but the colum it stands in – T-1. That is the exciting part! If there is communication down to T-1, then there is hope for all the zeros between it and C-4. And, if I'm able to recover that one connection after 17 years, then there's hope for all the zeros that come after it.

My light touch scores, which were already higher than pin prick, made a more significant jump.

Sensory exam, light touch

05/06/08

	C2	C3	C4	C5	C6	C7	C8	T1	T2	T3	T4	T5	T6	T7	T8
R	2	2	2	1	0	0	0	0	0	0	0	0	0	0	0	7
L	2	2	2	1	0	0	0	0	0	1	1	0	0	0	0	9

That's a total of 16. Just as is evident in my motor function, my left side is stronger.

After two months in therapy, my sensory function scored:

Sensory exam, light touch

10/07/08

	C2	C3	C4	C5	C6	C7	C8	T1	T2	T3	T4	T5	T6	T7	T8
R	2	2	2	0	0	0	0	0	1	1	0	0	0	0	0	8
L	2	2	2	1	0	0	0	1	0	2	1	0	0	0	0	11

And that is a total of 19. I'm very excited at all the numbers popping up down in the T level -- not to mention thrilled with what I'm now able to feel. For example, I can now sense hot and cold on my upper left arm, a few inches lower than I was previously able to feel. I can feel the stim on the back of my right shoulder, just below my scapular -- both the muscle contraction and the electrode being placed on my skin, neither of which I could sense in September.

If we can return, for a moment, to our ASIAn friend, you can see how my light touch scores translate over:

There are a few discrepancies between the two sets of results (e.g., there was presence of impaired sensation at right C-5 in May that did not manifest in October). Based solely on my own experience, I believe it is because sometimes, where my sensation is impaired, I have difficulty discerning between sensations. In some places,well below any levels that are scored on the ASIA exam, I can feel pressure, but no skin sensation. In other areas, I can feel something has touched me, but I don't feel the sharpness of the pin. So, it's often difficult to say, since I can't see what's going on and my sensory perception is not 100 percent.

Over all, my ASIA scores have gone from 12 and 16 to 13 and 19 on pin prick and light touch, respectively. We're heading in the right diection!

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.  

Prelude to a Re-eval

Originally, I'd intended to post the third and final part of the subluxation series today, however, your normally-scheduled reading is being preempted with some breaking news. (I'll resume the subluxation discussion this weekend with some really neat stuff about FES.)


Monday night (10/06/08), when Rich touched my arm, I gasped, and looked up at him, startled.

He snatched his hands back. "What? What's wrong?"

It wasn't any different than the way he usually does it – fingers lightly brushing against my shoulder and upper arm. The muted pressure under the surface of my skin was just as it always was when his fingers reached the middle of my upper arm, but accompanying that pressure was something new. What was different this time, I told him, "That tickled!"

A grin lit up his face, and he repeated the motion. "That?"

"Yes!" I said, probably looking more bewildered than vellicated by the touch, taking in the sensation as if for the first time. It had been so long since I'd felt anything but the vague echo of presence in that area of my arm that I'd forgotten anything was ever there; the sensation was almost unrecognizable. Bright ribbons of current followed his fingers across my skin and dissolved into white hot sparks that shot through the murky ether of my forearm and hand.

And, there it was – vibrant, unmistakable, alive. Sensation.

I can now feel an area in my left, upper arm that I have not been able to feel in 17 years.

"Big deal," you may say – and it may not sound like much, because it doesn't do much for me functionally – but, I assure you, it is big. It is huge. Beyond the augmented sensory perception – which, in itself, is very cool – the significance of this regained sensory function lies in what it indicates: that after 17 years, it can be recovered.

The experience I've just recounted; the experience, in this very moment, of my sleeve rubbing against my arm as I type these words – impossible, according to conventional thought on SCI. Sensory perception at that particular point of the arm is at level T-3. After 17 years at level C-4, I should not be able to feel that.

But, I do.

Tomorrow: re-eval and documented proof.