6 replies to this topic

[Tetracyclone]

I happened to be scanning through a curecare forum and came on this essay by Dr. Wise young that may be of interest to many, as there are frequently questions about the definitions of complete and incomplete. The thread is at http://sci.rutgers.e...ead.php?t=76227

For the Asia standards, in order to classify as incomplete a person must have sensation in the anus.

"Since I was in part responsible for proposing this definition, I should rise to its defense. In 1990, when I was co-chairing the ASIA committee on defining the classification of spinal cord injury, there were many definitions of "complete" and "incomplete" injuries, depending on the levels of partially preserved segments, how long the examination was done after injury, etc. Doctors were using the definition of "complete" injury almost in a punitive way, depriving people of hope of any recovery. It was simply not true that complete meant no recovery and yet many doctors were predicting to patients that they would not recover any function early after their injury.

So, I proposed the following definition of ASIA A. A person would have an ASIA A classification if that person has some spinal level below which he or she has no motor and sensory function. Since the anal area is the lowest level of the spinal cord, the absence of any sensation or motor function in the anus became the automatic definition of "complete". Of course, one needs to indicate the level of the "complete" loss of voluntary motor and sensory function.

Many studies have been carried out to assess the impact of this new definition since 1991. It turns out that this one finding (anal sensation and voluntary sphincter function) does predict the extent of recovery. Those people with have anal sensation and motor function recover significantly more function than those who do not.

Note: I want to add the following points:
The myth of "complete" spinal cord injury. The word "complete" spinal cord injury is a misleading term and should be applied only if there is confirmed transection of the spinal cord. Having no voluntary movement or sensation below the injury site does not mean that there is complete loss of all connections across the injury site. Many people, for example, still retain some ability to inhibit or increase spasms or spasticity in their legs even though they cannot voluntarily move them. For example, I have seen many people show increased spasticity in their legs when they are nervous or have been told a funny joke. A majority of people who are so-called "complete" spinal cord injured will recover at least one and sometimes 2 or more segmental levels of motor and sensory function, especially if they received methylprednisolone.
Spasms do not necessarily mean voluntary motor activity. Spasms of course mean that there are functional neurons and activity in your spinal cord. If you don't have voluntary control of the spasms, they may be spontaneous or arise from sensory stimulation from below the injury site. However, some people can control their spasms to some extent. Your question illustrates the problem with the definition of complete injury. It is much better to describe the phenomenon than to apply the definitions of complete and incomplete.
A vast majority of people do not have transected spinal cords. I have heard many people claim that they have been told by their doctors that they have "transected spinal cords". But, on closer questioning, it usually turns out to be an offhand remark by the doctor based on an MRI or CT scan. Please note that both MRI and CT scans may give the impression of a transected cord but the cord may not be transected. The only really confirmed cases of spinal cord transection that I know about are ones that have been observed in surgery. These are very rare.

Wise.
Last edited by Wise Young; 01-26-2007 at 01:35 AM.

02-19-2011, 04:19 PM #7
douglastneidermeyer
Junior Member



Join Date: Aug 2010
Location: Kingston, NY
Posts: 17
I am a T11/T12 and supposively "complete", until recently I gained back sensation in my anal region, after six years. Hello anus!

[Edinburgh Colin]

Interesting TC, I read quite a lot of Wise's stuff but he does produce an awful lot of reading matter when you start digging. A very knowledgeable gent though.

[Tetracyclone]

Yes, Colin. I keep a word doc of his comments when I run across them, slowly accumulating a tome. i call it Wise Words.

[Quad65]

So, let me see if I understand correctly. If you can feel your asshole and fart, you're an incomplete? Cool. I'm an incomplete.

[MTB John]

When they first tested me I had feeling on one side of my anus but not the other.. This apparently is pretty rare and started a great debate as to how to treat me. Thankfully the right doctor one as I am now ASIA D and am still making gains in my ability to walk..

[Snakeye]

[quote name='Quad65' timestamp='1299209706' post='212613']
So, let me see if I understand correctly. If you can feel your asshole and fart, you're an incomplete? Cool. I'm an incomplete.
[/quote

I can not only feel my asshole.. I sometimes am one...and I can fart like a baritone...so, what does that mean doc?

[Edinburgh Colin]

Snakeye
Talented and probably got skid marks too!