ASIA-ISCOS-IntlWorksheet

REV 04/19Page 1/2

This form may be copied freely but should not be altered without permission from the American Spinal Injury Association.

NEUROLOGICAL

LEVELS

Steps 1- 6 for classication

as on reverse

1. SENSORY

2. MOTOR

R L

3. NEUROLOGICAL

LEVEL OF INJURY

(NLI)

4. COMPLETE OR INCOMPLETE?

Incomplete = Any sensory or motor function in S4-5

5. ASIA IMPAIRMENT SCALE (AIS)

(In injuries with absent motor OR sensory function in S4-5 only)

6. ZONE OF PARTIAL

PRESERVATION

Most caudal levels with any innervation

SENSORY

MOTOR

R L

MOTOR SUBSCORES SENSORY SUBSCORES

UER +UEL = UEMS TOTAL

LER

+ LEL = LEMS TOTAL PPR + PPL = PP TOTALLTR + LTL = LT TOTAL

MAX

(25) (25) (50) (25)

(25) (50)

(56) (56)

(112)

MAX MAX

(56)

(112)

MAX

(50) (56) (56)

RIGHT TOTALS

(MAXIMUM)

(56) (56) (50)

LEFT TOTALS

(MAXIMUM)

(VAC) Voluntary Anal Contraction

(Yes/No)

(DAP) Deep Anal Pressure

(Yes/No)

S4-5

T10

T11

T12

S4-5

T10

T11

T12

RIGHT

LEFT

UER

(Upper Extremity Right)

LER

(Lower Extremity Right)

UEL

(Upper Extremity Left)

LEL

(Lower Extremity Left)

Elbow exors

Wrist extensors

Elbow extensors

Finger exors

Finger abductors (little nger)

Hip exors

Knee extensors

Ankle dorsiexors

Long toe extensors

Ankle plantar exors

Elbow exors

Wrist extensors

Elbow extensors

Finger exors

Finger abductors (little nger)

Hip exors

Knee extensors

Ankle dorsiexors

Long toe extensors

Ankle plantar exors

Pin Prick (PPR)Light Touch (LTR) Pin Prick (PPL)Light Touch (LTL)

SENSORY

KEY SENSORY POINTS

MOTOR

KEY MUSCLES

MOTOR

KEY MUSCLES

0 = Absent

1 = Altered

2 = Normal

NT = Not testable

0*, 1*, NT* = Non-SCI

condition present

SENSORY

(SCORING ON REVERSE SIDE)

0 = Total paralysis

1 = Palpable or visible contraction

2 = Active movement, gravity eliminated

3 = Active movement, against gravity

4 = Active movement, against some resistance

5 = Active movement, against full resistance

NT = Not testable

0*, 1*, 2*, 3*, 4*, NT* = Non-SCI condition present

MOTOR

(SCORING ON REVERSE SIDE)

Comments (Non-key Muscle? Reason for NT? Pain?

Non-SCI condition?):

S4-5

T10

T11

T12

Dorsum

Palm

Key Sensory

Points

Patient Name Date/Time of Exam

Examiner Name Signature

INTERNATIONAL STANDARDS FOR NEUROLOGICAL

CLASSIFICATION OF SPINAL CORD INJURY

(ISNCSCI)

Page 2/2

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

dened 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 decits, 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 Classication

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 specic 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

0 = Absent 1 = Altered, either decreased/impaired sensation or hypersensitivity

2 = Normal NT = Not testable

0*, 1*, NT* = Non-SCI condition present

In a patient with an apparent AIS B classication, 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 classication 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

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.

Dened 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.

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

classication purposes (at least normal / not normal for classication).

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 decits 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 classication)