INTERNATIONAL STANDARDS FOR NEUROLOGICAL Patient Name Date/Time of Exam

CLASSIFICATION OF SPINAL CORD INJURY

Examiner Name Signature
(ISNCSCI)
SENSORY SENSORY
RIGHT
MOTOR
KEY MUSCLES KEY SENSORY POINTS
Light Touch (LTR) Pin Prick (PPR)
KEY SENSORY POINTS
Light Touch (LTL) Pin Prick (PPL)
MOTOR
KEY MUSCLES LEFT
C2 1 1
C2
1 1 C2
C3 1 1 1 1 C3
C4 1 1 C2
1 1 C4
C3
C5 4 1 1 C3
1 1 4 C5 Elbow flexors
UER C6 4 1 1 C4 C4
1 1 3 C6 Wrist extensors UEL
(Upper Extremity Right) T2
C7 (Upper Extremity Left)
C7 3 2 1 T3 1 1 4 Elbow extensors
C8 C8
T4
3 2 1
T5
1 1 4 Finger flexors
T1 4 1 1 T6 1 1 4 T1 Finger abductors (little finger)
T2 1 1
T7
1 1 T2 MOTOR

C8
Comments (Non-key Muscle? Reason for NT? Pain? T8

C6
T3 T3 (SCORING ON REVERSE SIDE)

C7
Non-SCI condition?): 1 1 T9 1 1
T4 1 1
Dorsum
T10 1 1 T4 0 = Total paralysis
1 = Palpable or visible contraction
T5 T5
T11
1 1 1 1 2 = Active movement, gravity eliminated
3 = Active movement, against gravity
T6 T6
T12
1 1 L1 1 1 4 = Active movement, against some resistance
T7 1 1 Palm 1 1 T7 5 = Active movement, against full resistance
NT = Not testable
T8 1 1
S3
1 1 T8 0*, ..., 4*, NT* = Non-SCI condition present
T9 1 1 L2
Key Sensory
Points
1 1 T9
T10 1 1 S4-5
1 1 T10 SENSORY
(SCORING ON REVERSE SIDE)
T11 1 1 L 1 1 T11 0 = Absent NT = Not testable
T12 T12
2
2 1 L3 1 1 1 = Altered 0*, 1*, NT* = Non-SCI
L
S2 2 = Normal condition present
L1 1 1
3
1 1 L1
L2 2 1 1 1 1 2 L2 Hip flexors

LER L3 2 1 1 1 1 2 L3 Knee extensors

LEL
(Lower Extremity Right) L4 4 1 1 L4
1 1 4 L4 Ankle dorsiflexors (Lower Extremity Left)
L5 3 1 1 L
4
L5
1 1 2 L5 Long toe extensors
S1 2 1 1 S1 1 1 2 S1 Ankle plantar flexors
L5
S2 1 1 1 1 S2
S3 1 1 1 1 S3
(VAC) Voluntary Anal Contraction (DAP) Deep Anal Pressure
(Yes/No)
Yes S4-5 1 1 1 1 S4-5 Yes
(Yes/No)
RIGHT TOTALS 31 31 28 28 28 31 LEFT TOTALS
(MAXIMUM) (50) (56) (56) (56) (56) (50) (MAXIMUM)
MOTOR SUBSCORES SENSORY SUBSCORES
UER 18 +UEL 19 = UEMS TOTAL 37 LER 13 + LEL 12 = LEMS TOTAL 25 LTR 31 + LTL 28 = LT TOTAL 59 PPR 28 + PPL 28 = PP TOTAL 56
MAX (25) (25) (50) MAX (25) (25) (50) MAX (56) (56) (112) MAX (56) (56) (112)

NEUROLOGICAL R L 4. COMPLETE OR INCOMPLETE? (In injuries with absent motor OR sensory function in S4-5 only) R L
3. NEUROLOGICAL 6. ZONE OF PARTIAL SENSORY
LEVELS 1. SENSORY C1 Incomplete = Any sensory or motor function in S4-5
I
C1
LEVEL OF INJURY C1 NA NA
Steps 1- 6 for classification
2. MOTOR C1 C1 (NLI) 5. ASIA IMPAIRMENT SCALE (AIS) D PRESERVATION MOTOR NA NA
as on reverse Most caudal levels with any innervation

This form may be copied freely but should not be altered without permission from the American Spinal Injury Association. REV 04/19
Muscle Function Grading ASIA Impairment Scale (AIS) Steps in Classification
0 = Total paralysis The following order is recommended for determining the classification of
individuals with SCI.
1 = Palpable or visible contraction A = Complete. No sensory or motor function is preserved
1. Determine sensory levels for right and left sides.
2 = Active movement, full range of motion (ROM) with gravity eliminated in the sacral segments S4-5.
The sensory level is the most caudal, intact dermatome for both pin prick
3 = Active movement, full ROM against gravity and light touch sensation.
B = Sensory Incomplete. Sensory but not motor function
4 = Active movement, full ROM against gravity and moderate resistance in a is preserved below the neurological level and includes the
muscle specific position 2. Determine motor levels for right and left sides.
sacral segments S4-5 (light touch or pin prick at S4-5 or
5 = (Normal) active movement, full ROM against gravity and full resistance in a deep anal pressure) AND no motor function is preserved Defined by the lowest key muscle function that has a grade of at least 3 (on
functional muscle position expected from an otherwise unimpaired person supine testing), providing the key muscle functions represented by segments
more than three levels below the motor level on either side
NT = Not testable (i.e. due to immobilization, severe pain such that the patient above that level are judged to be intact (graded as a 5).
of the body.
cannot be graded, amputation of limb, or contracture of > 50% of the normal ROM) 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
0*, ..., 4*, NT* = Non-SCI condition present a C = Motor Incomplete. Motor function is preserved at the
above that level is also normal.
most caudal sacral segments for voluntary anal contraction
Sensory Grading (VAC) OR the patient meets the criteria for sensory
incomplete status (sensory function preserved at the most 3. Determine the neurological level of injury (NLI)
0 = Absent 1 = Altered, either decreased/impaired sensation or hypersensitivity This refers to the most caudal segment of the cord with intact sensation and
caudal sacral segments (S4-S5) by LT, PP or DAP), and has
2 = Normal NT = Not testable some sparing of motor function more than three levels below antigravity (3 or more) muscle function strength, provided that there is normal
the ipsilateral motor level on either side of the body. (intact) sensory and motor function rostrally respectively.
0*, 1*, NT* = Non-SCI condition present a The NLI is the most cephalad of the sensory and motor levels determined in
(This includes key or non-key muscle functions to determine
a
Note: Abnormal motor and sensory scores should be tagged with a “*” to indicate an steps 1 and 2.
motor incomplete status.) For AIS C – less than half of key
impairment due to a non-SCI condition. The non-SCI condition should be explained
muscle functions below the single NLI have a muscle grade 4. Determine whether the injury is Complete or Incomplete.
in the comments box together with information about how the score is rated for
classification purposes (at least normal / not normal for classification). ≥ 3. (i.e. absence or presence of sacral sparing)
If voluntary anal contraction = No AND all S4-5 sensory scores = 0
When to Test Non-Key Muscles: D = Motor Incomplete. Motor incomplete status as AND deep anal pressure = No, then injury is Complete.
defined above, with at least half (half or more) of key muscle Otherwise, injury is Incomplete.
In a patient with an apparent AIS B classification, non-key muscle functions functions below the single NLI having a muscle grade ≥ 3.
more than 3 levels below the motor level on each side should be tested to 5. Determine ASIA Impairment Scale (AIS) Grade:
most accurately classify the injury (differentiate between AIS B and C). Is injury Complete? If YES, AIS=A
E = Normal. If sensation and motor function as tested with
Movement Root level the ISNCSCI are graded as normal in all segments, and the
patient had prior deficits, then the AIS grade is E. Someone
Shoulder: Flexion, extension, adbuction, adduction, internal Is injury Motor Complete? If YES, AIS=B
without an initial SCI does not receive an AIS grade.
and external rotation C5
Elbow: Supination (No=voluntary anal contraction OR motor
Using ND: To document the sensory, motor and NLI levels, function more than three levels below the motor
Elbow: Pronation the ASIA Impairment Scale grade, and/or the zone of partial level on a given side, if the patient has sensory
Wrist: Flexion
C6 preservation (ZPP) when they are unable to be determined incomplete calssification)
based on the examination results.
Finger: Flexion at proximal joint, extension Are at least half (half or more) of the key muscles below the
Thumb: Flexion, extension and abduction in plane of thumb C7
neurological level of injury graded 3 or better?
Finger: Flexion at MCP joint
Thumb: Opposition, adduction and abduction perpendicular C8
to palm
Finger: Abduction of the index finger T1 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
Hip: Adduction L2 SCI has recovered normal function. If at initial testing no deficits are found, the
individual is neurologically intact: the ASIA Impairment Scale does not apply.
Hip: External rotation L3 INTERNATIONAL STANDARDS FOR NEUROLOGICAL
Hip: Extension, abduction, internal rotation CLASSIFICATION OF SPINAL CORD INJURY 6. Determine the zone of partial preservation (ZPP)
Knee: Flexion The ZPP is used only in injuries with absent motor (no VAC) OR sensory
Ankle: Inversion and eversion
L4 function (no DAP and no LT and no PP sensation) in the lowest sacral
Toe: MP and IP extension segments S4-5, and refers to those dermatomes and myotomes caudal to the
sensory and motor levels that remain partially innervated. With sacral sparing
Hallux and Toe: DIP and PIP flexion and abduction L5 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
Hallux: Adduction S1 motor ZPP is not applicable and is noted as “NA”.