Determining an ASIA Score and the Role of a Physiatrist in Neurorehabilitation

If you don’t have a significant injury or medical condition, you don’t need a physiatrist. You can stop reading.

But if you do have one of the above things, a physiatrist can be one of the most valuable treatment partners you have.

A physiatrist is like a physical therapist, except a medical doctor. His or her specialty is in physical medicine and rehabilitation. Many of them have sub specialties in brain injury, spinal cord injury, neurodegenerative diseases, or orthopedics.

Their focus is on improving function, and unlike most doctors (sorry, most doctors), they have a superb understanding of how the body moves. I have been going to specialists for a very long time, and I will tell you that most general practitioners, liver specialists, neurologists, gynecologists, endocrinologists, etc know slightly more than not very much about movement (and much less than most Pilates professionals or highly trained exercise instructors know).

Today at Kennedy Krieger Institute, I met with their resident physiatrist, Dr. Recio. There was another doctor present, whose name I forget, but who was doing specialized training as a spinal cord injury doctor.

Similar to my first meeting with a physical therapist this week, Dr. Recio did a lot of muscle strength and range of motion tests. He watched my gait (I tripped twice for him – which is actually rare for me – so I guess, um, thanks multiple sclerosis, for showing your tricks today).

Unlike the less specific tests done by the neurophysical therapist, Dr. Recio was trying to figure out my ASIA score. ASIA is an acronym for “American Spinal Injury Association,” and the ASIA score is designed to measure a patient’s spinal cord injury to help figure out a plan for rehabilitation. The doctor measures the strength of 10 muscles (5 upper body/both sides and 5 lower body/both sides). All of my upper body scores were 5. My lower body scores were 5 (complete strength, full range of motion) on everything except hip flexor (4 both sides) and left side dorsifelxor (which scored a 1, which shows there’s a visible weakness and lack of mobility through a normal range of motion).

NEUROREHAB Blog - ASIA photo1.jpg

Apparently, I had an “astonishing” result once he started testing sensory nerves. Although I have measurable weakness in a couple of muscles in my legs, I have zero impact on sensation. Evidently, this is not something he ever sees (oh, to be a medical mystery).

To test sensation, the ASIA test looks at soft touch (sensory nerves for these are close to the surface), which they test by running a Q-tip along your skin to see if you can feel it, and pain, which uses the pinprick test. The doctor uses a stick pin and sticks either the sharp side or the dull side on your body at different points and you say whether it’s the sharp side or not. The spots they hit are called dermatomes, a patch of skin innervated (i.e. The nerves come from the spinal cord to there) at different spinal cord levels.

Somehow (medical mystery), I have a 100% intact sensory system while simultaneously having neurologically affected muscles.

Here’s why that’s so weird.

NEUROREHAB Blog - ASIA photo2.jpg

This is the drawing Dr. Recio made to explain it to me. Look to the right side of the drawing. Do you see the green dot with a triangular shape green thing under it? The green dot that’s on top represents the sensory nerves for the pinprick test. The dot underneath (which he “erased” a little to represent weakness), represents the motor pathways for my leg muscles. They are right next to each other, and somehow, the MS damage I have managed to bypass the (very, very close) sensory system.

So, my ASIA Score is L1 (lumbar 1, indicating the lowest level on the spinal cord was function is still perfect – for me, it’s at the 1st lumbar vertebra), ASIA D. The ASIA Score runs A-E, with A being a complete spinal cord injury (paralysis) and B-D being different measurements of how affected you are (B more, D less). E would be normal function.

This wasn’t the only thing I did today. My meeting with him was over two hours, so I had no physical therapy, but I did have a brief meeting with the social worker and then a full body DEXA scan (bone test – I’ll blog about that soon). Dr. Recio assured me that they had many, many things to do with me that I haven’t tried yet, and that they are the best neurorehab hospital in the country with the most tools for treatment. As nice as everyone is here, I’m inclined to believe he’s right.

There will be a likely change in plans, though. Dr. Recio thinks they need to Botox my leg (again) to weaken the spasticity in my left calf before they try all their rehab tricks. So, I’m not sure if I’ll be here all week next week as well, or if we’re going to move to long term treatment, twice a week for several months.

Stay tuned!

In health,


Aquatherapy for Gait Training

Adventures in Neurorehab – Day 2: Gait, and Stairs, and Therapy Monkeys – Oh My!