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A = Complete. No sensory or motor function is preserved
in the sacral segments S4-5.
B = Sensory Incomplete. Sensory but not motor function
is preserved below the neurological level and includes the
sacral segments S4-5 (light touch or pin prick at S4-5 or
deep anal pressure) AND no motor function is preserved
more than three levels below the motor level on either side
of the body.
C = Motor Incomplete. Motor function is preserved at the
most caudal sacral segments for voluntary anal contraction
(VAC) OR the patient meets the criteria for sensory
incomplete status (sensory function preserved at the most
caudal sacral segments S4-5 by LT, PP or DAP), and has
some sparing of motor function more than three levels below
the ipsilateral motor level on either side of the body.
(This includes key or non-key muscle functions to determine
motor incomplete status.) For AIS C – less than half of key
muscle functions below the single NLI have a muscle
grade ≥ 3.
D = Motor Incomplete. Motor incomplete status as
dened above, with at least half (half or more) of key muscle
functions below the single NLI having a muscle grade ≥ 3.
E = Normal. If sensation and motor function as tested with
the ISNCSCI are graded as normal in all segments, and the
patient had prior decits, then the AIS grade is E. Someone
without an initial SCI does not receive an AIS grade.
Using ND: To document the sensory, motor and NLI levels,
the ASIA Impairment Scale grade, and/or the zone of partial
preservation (ZPP) when they are unable to be determined
based on the examination results.
ASIA Impairment Scale (AIS) Steps in Classication
Muscle Function Grading
Sensory Grading
When to Test Non-Key Muscles:
0 = Total paralysis
1 = Palpable or visible contraction
2 = Active movement, full range of motion (ROM) with gravity eliminated
3 = Active movement, full ROM against gravity
4 = Active movement, full ROM against gravity and moderate resistance in a
muscle specic position
5 = (Normal) active movement, full ROM against gravity and full resistance in a
functional muscle position expected from an otherwise unimpaired person
NT = Not testable (i.e. due to immobilization, severe pain such that the patient
cannot be graded, amputation of limb, or contracture of > 50% of the normal ROM)
0*, 1*, 2*, 3*, 4*, NT* = Non-SCI condition present
a
0 = Absent 1 = Altered, either decreased/impaired sensation or hypersensitivity
2 = Normal NT = Not testable
0*, 1*, NT* = Non-SCI condition present
a
In a patient with an apparent AIS B classication, non-key muscle functions
more than 3 levels below the motor level on each side should be tested to
most accurately classify the injury (differentiate between AIS B and C).
The following order is recommended for determining the classication of
individuals with SCI.
INTERNATIONAL STANDARDS FOR NEUROLOGICAL
CLASSIFICATION OF SPINAL CORD INJURY
Movement
Shoulder:
Flexion, extension, adbuction, adduction,
internal and external rotation
Elbow:
Supination
Elbow:
Pronation
Wrist:
Flexion
Finger:
Flexion at proximal joint, extension
Thumb:
Flexion, extension and abduction in plane of thumb
Finger:
Flexion at MCP joint
Thumb:
Opposition, adduction and abduction
perpendicular to palm
Finger:
Abduction of the index nger
Hip:
Adduction
Hip:
External rotation
Hallux and Toe:
DIP and PIP exion and abduction
Hallux:
Adduction
Hip:
Extension, abduction, internal rotation
Knee:
Flexion
Ankle:
Inversion and eversion
Toe:
MP and IP extension
Root level
C5
C6
C7
C8
T1
L2
L3
L4
L5
S1
4. Determine whether the injury is Complete or Incomplete.
(i.e. absence or presence of sacral sparing)
If voluntary anal contraction = No AND all S4-5 sensory scores = 0
AND deep anal pressure = No, then injury is Complete.
Otherwise, injury is Incomplete.
6. Determine the zone of partial preservation (ZPP).
The ZPP is used only in injuries with absent motor (no VAC) OR sensory
function (no DAP, no LT and no PP sensation) in the lowest sacral segments
S4-5, and refers to those dermatomes and myotomes caudal to the sensory
and motor levels that remain partially innervated. With sacral sparing of
sensory function, the sensory ZPP
is not applicable and therefore “NA” is
recorded in the block of the worksheet. Accordingly, if VAC is present, the
motor ZPP is not applicable and is noted as “NA”.
3. Determine the neurological level of injury (NLI).
This refers to the most caudal segment of the cord with intact sensation and
antigravity (3 or more) muscle function strength, provided that there is normal
(intact) sensory and motor function rostrally respectively.
The NLI is the most cephalad of the sensory and motor levels determined in
steps 1 and 2.
2. Determine motor levels for right and left sides.
Dened by the lowest key muscle function that has a grade of at least 3 (on
supine testing), providing the key muscle functions represented by segments
above that level are judged to be intact (graded as a 5).
Note: in regions where there is no myotome to test, the motor level is
presumed to be the same as the sensory level, if testable motor function
above that level is also normal.
1. Determine sensory levels for right and left sides.
The sensory level is the most caudal, intact dermatome for both pin prick
and light touch sensation.
a
Note: Abnormal motor and sensory scores should be tagged with a ‘*’ to indicate an
impairment due to a non-SCI condition. The non-SCI condition should be explained
in the comments box together with information about how the score is rated for
classication purposes (at least normal / not normal for classication).
5. Determine ASIA Impairment Scale (AIS) Grade.
Is injury Complete? If YES, AIS=A
Is injury Motor Complete? If YES, AIS=B
Are at least half (half or more) of the key muscles below the
neurological level of injury graded 3 or better?
If sensation and motor function is normal in all segments, AIS=E
Note: AIS E is used in follow-up testing when an individual with a documented
SCI has recovered normal function. If at initial testing no decits are found, the
individual is neurologically intact and the ASIA Impairment Scale does not apply.
(No=voluntary anal contraction OR motor
function more than three levels below the motor
level on a given side, if the patient has sensory
incomplete classication)