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INTERNATIONAL STANDARDS FOR NEUROLOGICAL Patient Name_____________________________________ Date/Time of Exam _____________________________ CLASSIFICATION OF SPINAL CORD INJURY Examiner Name ___________________________________ Signature _____________________________________ (ISNCSCI) MOTOR SENSORY SENSORY MOTOR KEY SENSORY POINTS KEY SENSORY POINTS KEY MUSCLES KEY MUSCLES RIGHT Light Touch (LTR) Pin Prick (PPR) Light Touch (LTL) Pin Prick (PPL) LEFT Patient Name_____________________________________ Date/Time of Exam _____________________________ C2 INTERNATIONAL STANDARDS FOR NEUROLOGICAL C2 CLASSIFICATION OF SPINAL CORD INJURY C3 Examiner Name ___________________________________C3 Signature _____________________________________ (ISNCSCI) C4 C2 C4 Elbow flexors C5 MOTOR SENSORYC3 SENSORYC5 Elbow flexors MOTOR KEY SENSORY POINTS KEY SENSORY POINTS UER Wrist extensors C6 KEY MUSCLES C4 C6 Wrist extensors KEY MUSCLESUEL RIGHT Light Touch (LTR) Pin Prick (PPR) Patient Name_____________________________________Light Touch (LTL) Pin Prick (PPL) Date/Time of Exam _____________________________LEFT (Upper Extremity Right) INTERNATIONAL STANDARDS FOR NEUROLOGICAL T2 (Upper Extremity Left) Elbow extensors C7 C2 T3 C7 Elbow extensors CLASSIFICATION OF SPINALC2 CORD INJURYT4 C5 C2 Finger flexors C8 Examiner Name ___________________________________C8 Finger flexors Signature _____________________________________ 0 = absent (ISNCSCI) T5 1 = altered C3 C3 Finger abductors (little finger) T6 Finger abductors (little finger) T1 2 = normal T1 C4 C2 C4 NT = not testable SENSORYT7 SENSORY T2 MOTOR C3 T2 Comments (Non-key Muscle? Reason for NT? Pain?): T8 C3 MOTORMOTORElbow flexors Elbow flexors C5 KEY SENSORY POINTS KEY SENSORY POINTS C5 RIGHTT3 KEY MUSCLES 0 = absent T9 T1 T3 (SCORING ON REVERSEKEY MUSCLES SIDE) LEFT Light Touch (LTR) Pin Prick (PPR) C4 Light Touch (LTL) Pin Prick (PPL) UER Wrist extensors C6 1 = altered C6 Wrist extensors UEL C4 T10 C6 (Upper Extremity Right) T4 2 = normal T2 T4 0 = total paralysis (Upper Extremity Left) Elbow extensors C7 C2 NT = not testable T11 C2 T3 1 = palpable or visible contractionC2 C7 Elbow extensors T5 C5 T5 T4 2 = active movement, gravity eliminated Finger flexors C8 0 = absentC3 T12 C3 C8 Finger flexors T5 3 = active movement, against gravity 0 = absent T6 1 = altered L1 T6 Finger abductors (little finger) Palm C2T6 C4 Finger abductors (little finger) 1 = altered T1 2 = normalC4 4 = active movement, against some resistanceT1 T7 T7 2 = normal T7 NT = not testable C3 5 = active movement, against full resistance Elbow flexors T2 C3 T2 C5 Elbow flexors NT = not testable Comments (Non-key Muscle? Reason for NT? Pain?):C5 T8 T8 5* = normal corrected for pain/disuse MOTOR T8 C4 UER Wrist extensors C6 T3 S3 0 = absent T9 T1 NT = not testable T3 C6 (SCORINGWrist extensors ON REVERSE SIDE) UEL 1Key = altered SensoryC4 T2 T9 (Upper Extremity Right) T9 L2 • T10 C6 (Upper Extremity Left) Elbow extensors T4 S4-5 2 = normalC2 T3 T4 0 = totalElbow paralysis extensors C7 NT Points= not testable T11 C7 T10 T4 C5 T10 SENSORY 1 = palpable or visible contraction Finger flexors T5 T5 C8 Finger flexors C8 0 = absent T5T12 T11 (SCORING ON REVERSE 2SIDE) = active movement, gravity eliminated T11 1 = altered T6 3 = active movement, against gravity Finger0 abductors= absent (little finger) T6 T6 L1 T1 Finger abductors (little finger) T1 2 = normal Palm 0 = absent 2 = normal T121 = altered T7 T12 4 = active movement, against some resistance NT = not T7testableS2 L3 1= altered T7 NT = not testable 2 = normal T2 C3 C8 C8 T8 T2 5 = active movement, against full resistance Comments (Non-key Muscle?NTL1 = not testableReason for NT? Pain?): C6 C6 L1 5* = normal correctedMOTOR for pain/disuse T8 0 = absentC7 C7 T9 T1 T8 T3 S3 T3 (SCORING ON REVERSE SIDE) 1 = alteredC4 NT = not testable Hip flexors L2 Dorsum Dorsum T10 KeyC6 Sensory L2 Hip flexors T9 T4T9 2 = normal L2 • T4 0 = total paralysis NT = not testableS4-5 T11 LER Knee extensors L3 T10T5 Points L3 Knee extensorsT5T10 1 = palpableLEL or SENSORYvisible contraction L4 T12 T11 2 = active(SCORING movement, ON gravity REVERSE eliminated SIDE) (Lower Extremity Right) Ankle dorsiflexors L4 T11T6 L1 L4 Ankle dorsiflexorsT6 (Lower 3 = active Extremity movement, Left) against gravity 0 = absent L5 0 = absent 2 = normal Long toe extensors 1 = altered T12 Palm T12 4 = active movement, against some resistance L5 T7 S2 L3 L5 Long toe extensorsT7 1= altered NT = not testable 2 = normal S1 C8 C8 5 = active movement, against full resistance Ankle plantar flexors S1 NT = not testable L1L5 C6 C6 Ankle plantar T8L1flexors 5* = normal corrected for pain/disuse T8 S3 C7 C7 S1 Key Sensory NT = not testable S2 Hip flexors L2 T9 L2 Dorsum• Dorsum S2 T9 L2 Hip flexors S4-5 Points S3 Knee extensors L3 T10 S3 T10 L3 Knee extensorsSENSORY (VAC) Voluntary anal contraction LER L4 (DAP) Deep anal pressure LEL S4-5 Ankle dorsiflexors L4 S4-5 T11 (SCORING ON REVERSE SIDE) (Yes/No) (Lower Extremity Right) T11 (Yes/No) L4 Ankle dorsiflexors (Lower Extremity Left) L5 0 = absent 2 = normal Long toe extensors L5 T12 L3 T12 S2 L51= alteredLong toe extensors NT = not testable RIGHT TOTALS S1 C8 C8 LEFT TOTALS Ankle plantar flexors S1 L1 L5 C6 C6 L1 S1 Ankle plantar flexors (MAXIMUM) C7 C7 (MAXIMUM) Hip flexors L2 S2 Dorsum Dorsum S2 L2 Hip flexors MOTOR SUBSCORES SENSORY SUBSCORES Knee extensors L3 S3 S3 L3 Knee extensors (VAC) VoluntaryLER anal contraction L4 (DAP) Deep anal pressureLEL UER + UEL = UEMS TOTAL LER + LEL S4-5= LEMS TOTAL LTR + LTL = LT TOTAL PPR + PPL S4-5 = PP TOTAL (Lower Extremity Right) (Yes/No)Ankle dorsiflexors L4 L4 Ankle dorsiflexors(Yes/No) (Lower Extremity Left) MAX (25) (25) (50) MAX (25) (25) (50) L5 Long toe extensors L5 MAX (56) (56) (112) MAX (56) (56) Long toe (112)extensors S1 L5LEFT TOTALS RIGHT TOTALS Ankle plantar flexors S1 L5 (In complete injuries only) Ankle plantar flexors NEUROLOGICAL R L 3. NEUROLOGICAL(MAXIMUM) 4. COMPLETE OR INCOMPLETE? S1(MAXIMUM) R L LEVELS 1. SENSORY S2 Incomplete = Any sensory or motor function in S4-5 ZONE OF PARTIAL S2SENSORY MOTOR SUBSCORES LEVEL OF INJURY SENSORY SUBSCORES Steps 1-5 for classification S3 PRESERVATION S3MOTOR as on reverse 2. MOTOR (NLI) 5. ASIA IMPAIRMENT SCALE (AIS) Most caudal level with any innervation (VAC)UER Voluntary + UELAnal Contraction= UEMS TOTAL S4-5LER + LEL = LEMS TOTAL LTR + LTL = LT TOTAL S4-5 PPR + PPL(DAP) Deep= AnalPP TOTAL Pressure (Yes/No) MAX (25)This (25) form may be copied freely(50) but shouldMAX not(25) be altered without (25) permission from the (50)American SpinalMAX Injury(56) Association. (56) (112) MAX (56)REV (Yes/No)02/13 (56) (112) RIGHT TOTALS (In complete injuriesLEFT only) TOTALS NEUROLOGICAL R L 3. NEUROLOGICAL 4. COMPLETE OR INCOMPLETE? R L (MAXIMUM) ZONE OF PARTIAL(MAXIMUM) LEVELS 1. SENSORY LEVEL OF INJURY Incomplete = Any sensory or motor function in S4-5 SENSORY MOTORSteps 1-5 SUBSCORES for classification PRESERVATION MOTOR as on reverse 2. MOTOR (NLI) 5. ASIA SENSORYIMPAIRMENT SUBSCORES SCALE (AIS) Most caudal level with any innervation UER + UEL = UEMS TOTAL LER + LEL = LEMS TOTAL LTR + LTL = LT TOTAL PPR + PPL = PP TOTAL This form may be copied freely but should not be altered without permission from the American Spinal Injury Association. REV 02/13 MAX (25) (25) (50) MAX (25) (25) (50) MAX (56) (56) (112) MAX (56) (56) (112) NEUROLOGICAL R L 4. COMPLETE OR INCOMPLETE? (In complete injuries only) R L 3. NEUROLOGICAL ZONE OF PARTIAL LEVELS 1. SENSORY LEVEL OF INJURY Incomplete = Any sensory or motor function in S4-5 SENSORY Steps 1-5 for classification PRESERVATION MOTOR as on reverse 2. MOTOR (NLI) 5. ASIA IMPAIRMENT SCALE (AIS) Most caudal level with any innervation This form may be copied freely but should not be altered without permission from the American Spinal Injury Association. REV 11/15 Muscle Function Grading ASIA Impairment Scale (AIS) Steps in Classification 0 = total paralysis The following order is recommended for determining the classification of 1 = palpable or visible contraction individuals with SCI. No sensory or motor function is preserved in 2 = active movement, full range of motion (ROM) with gravity eliminated A = Complete. the sacral segments S4-5. 1. Determine sensory levels for right and left sides. 3 = active movement, full ROM against gravity The sensory level is the most caudal, intact dermatome for both pin prick and 4 = active movement, full ROM against gravity and moderate resistance in a muscle specific position B = Sensory Incomplete. Sensory but not motor function light touch sensation. is preserved below the neurological level and includes the sacral = (normal) active movement, full ROM against gravity and full resistance in a 5 segments S4-5 (light touch or pin prick at S4-5 or deep anal 2. Determine motor levels for right and left sides. functional muscle position expected from an otherwise unimpaired person pressure) AND no motor function is preserved more than three Defined by the lowest key muscle function that has a grade of at least 3 (on = (normal) active movement, full ROM against gravity and sufficient resistance to 5* levels below the motor level on either side of the body. supine testing), providing the key muscle functions represented by segments be considered normal if identified inhibiting factors (i.e. pain, disuse) were not present above that level are judged to be intact (graded as a 5). NT = not testable (i.e. due to immobilization, severe pain such that the patient Note: in regions where there is no myotome to test, the motor level is C = Motor Incomplete. Motor function is preserved at the cannot be graded, amputation of limb, or contracture of > 50% of the normal ROM) presumed to be the same as the sensory level, if testable motor function above most caudal sacral segments for voluntary anal contraction (VAC) that level is also normal. Sensory Grading OR the patient meets the criteria for sensory incomplete status (sensory function preserved at the most caudal sacral segments 0 = Absent 3.
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