Professional Documents
Culture Documents
S2 Hip flexors L2 T9
S3
L2 • Key
Dorsum Sensory
Dorsum S2 T9
NT = not testable
L2 Hip flexors
Points
S3 Knee extensors L3 T10 S4-5
S3 T10 L3 SENSORY
raction LER L4 (DAP) Deep anal(SCORING
Knee extensors
pressureON REVERSE SIDE) LEL
Yes/No) (Lower Extremity Right) S4-5 Ankle dorsiflexors L4 T11 S4-5 T11 L4 Ankle dorsiflexors (Lower Extremity Left)
L5 (Yes/No) 0 = absent
Long toe extensors L5 T12 S2 L3 T12 L5
2 = normal
Long toe extensors NT = not testable
1= altered
8 C8 LEFT TOTALS
RIGHT TOTALS Ankle plantar flexors S1 L1 S1
C6
C
C6 L1
L5 C7 C7 S1 Ankle plantar flexors
(MAXIMUM) (MAXIMUM)
Hip flexors L2 S2 Dorsum Dorsum S2 L2 Hip flexors
S SENSORY SUBSCORES
Knee extensors L3 S3 S3 L3 Knee extensors LEL
= UEMS TOTAL LER
(VAC) Voluntary anal contraction
LER + LEL = LEMS TOTAL
S4-5 + LTL L4 + PPL S4-5 = PP TOTAL
(DAP) Deep anal pressure
(Lower Extremity Right) (Yes/No)Ankle dorsiflexors L4 LTR = LT TOTAL PPR
L4 Ankle dorsiflexors
(Yes/No) (Lower Extremity Left)
(50) (25) (25) (50) L5
MAX
Long toe extensors L5 MAX (56) (56) (112) MAX (56) (56)
L5LEFT Long (112)
toe extensors
TOTALS
RIGHT TOTALS S1
R L Ankle plantar flexors S1 L5
4. COMPLETE OR INCOMPLETE? (In complete injuries only) S1(MAXIMUM)
Ankle
R plantar L flexors
(MAXIMUM)
3. NEUROLOGICAL
1. SENSORY
MOTOR SUBSCORES S2 Incomplete = Any sensory or motor function in S4-5 ZONE OF PARTIAL S2
SENSORY
LEVEL OF INJURY SENSORY SUBSCORES
2. MOTOR (NLI) S3 5. ASIA IMPAIRMENT SCALE (AIS) PRESERVATION S3MOTOR
(VAC)
UER Voluntary Anal Contraction
+ UEL = UEMS TOTAL S4-5 LER + LEL = LEMS TOTAL LTR Most caudal level with any innervation
+ LTL = LT TOTAL S4-5 PPR + PPL (DAP) Deep= Anal PP TOTALPressure
MAX (25) (25)
This (Yes/No) (50)but should
form may be copied freely MAXnot(25) (25) permission from the (50)
be altered without American Spinal
MAXInjury
(56) Association.
(56) (112) MAX (56) REV (Yes/No)
02/13(56) (112)
RIGHT TOTALS LEFT TOTALS
NEUROLOGICAL R L 3. NEUROLOGICAL 4. COMPLETE OR INCOMPLETE? (In complete injuries only) R L
LEVELS (MAXIMUM) (MAXIMUM)
ZONE OF PARTIAL
1. SENSORY LEVEL OF INJURY Incomplete = Any sensory or motor function in S4-5 SENSORY
MOTOR
Steps 1-5SUBSCORES
for classification PRESERVATION
as on reverse 2. MOTOR (NLI) 5. ASIA SENSORY
IMPAIRMENTSUBSCORES
SCALE (AIS) Most caudal level with any innervation
MOTOR
UER + UEL = UEMS TOTAL LER + LEL = LEMS TOTAL LTR + LTL = LT TOTAL PPR + PPL = PP TOTAL REV 02/13
This form may be copied freely but should not be altered without permission from the American Spinal Injury Association.
MAX (25) (25) (50) MAX (25) (25) (50) MAX (56) (56) (112) MAX (56) (56) (112)
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.
2 = active movement, full range of motion (ROM) with gravity eliminated A = Complete. No sensory or motor function is preserved in
the sacral segments S4-5. 1. Determine sensory levels for right and left sides.
3 = a ctive 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 B = Sensory Incomplete. Sensory but not motor function light touch sensation.
specific position
is preserved below the neurological level and includes the sacral
5 = (normal) active movement, full ROM against gravity and full resistance in a 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 Defined by the lowest key muscle function that has a grade of at least 3 (on
pressure) AND no motor function is preserved more than three
5* = (normal) active movement, full ROM against gravity and sufficient resistance to 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
cannot be graded, amputation of limb, or contracture of > 50% of the normal ROM) C = Motor Incomplete. Motor function is preserved at the 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. Determine the neurological level of injury (NLI)
(S4-S5) by LT, PP or DAP), and has some sparing of motor
1 = Altered, either decreased/impaired sensation or hypersensitivity function more than three levels below the ipsilateral motor level
This refers to the most caudal segment of the cord with intact sensation and
2 = Normal antigravity (3 or more) muscle function strength, provided that there is normal
on either side of the body. (intact) sensory and motor function rostrally respectively.
NT = Not testable (This includes key or non-key muscle functions to determine The NLI is the most cephalad of the sensory and motor levels determined in
motor incomplete status.) For AIS C – less than half of key
When to Test Non-Key Muscles: muscle functions below the single NLI have a muscle grade ≥ 3.
steps 1 and 2.
In a patient with an apparent AIS B classification, non-key muscle functions 4. Determine whether the injury is Complete or Incomplete.
more than 3 levels below the motor level on each side should be tested to D = Motor Incomplete. Motor incomplete status as defined
most accurately classify the injury (differentiate between AIS B and C). (i.e. absence or presence of sacral sparing)
above, with at least half (half or more) of key muscle functions If voluntary anal contraction = No AND all S4-5 sensory scores = 0
Movement Root level below the single NLI having a muscle grade ≥ 3. AND deep anal pressure = No, then injury is Complete.
Shoulder: Flexion, extension, abduction, adduction, internal C5 Otherwise, injury is Incomplete.
and external rotation E = Normal. If sensation and motor function as tested with
Elbow: Supination the ISNCSCI are graded as normal in all segments, and the 5. Determine ASIA Impairment Scale (AIS) Grade:
Elbow: Pronation C6 patient had prior deficits, then the AIS grade is E. Someone Is injury Complete? If YES, AIS=A and can record
Wrist: Flexion without an initial SCI does not receive an AIS grade. ZPP (lowest dermatome or myotome
NO on each side with some preservation)
Finger: Flexion at proximal joint, extension. C7 Using ND: To document the sensory, motor and NLI levels,
Thumb: Flexion, extension and abduction in plane of thumb the ASIA Impairment Scale grade, and/or the zone of partial Is injury Motor Complete? If YES, AIS=B
Finger: Flexion at MCP joint C8 preservation (ZPP) when they are unable to be determined
based on the examination results. NO (No=voluntary anal contraction OR motor function
Thumb: Opposition, adduction and abduction perpendicular
more than three levels below the motor level on a
to palm
given side, if the patient has sensory incomplete
Finger: Abduction of the index finger T1 classification)
Hip: Adduction L2 Are at least half (half or more) of the key muscles below the
Hip: External rotation L3 neurological level of injury graded 3 or better?
Hip: Extension, abduction, internal rotation L4 NO YES
Knee: Flexion
Ankle: Inversion and eversion
INTERNATIONAL STANDARDS FOR NEUROLOGICAL AIS=C AIS=D
Toe: MP and IP extension
CLASSIFICATION OF SPINAL CORD INJURY If sensation and motor function is normal in all segments, AIS=E
Hallux and Toe: DIP and PIP flexion and abduction L5 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 deficits are found, the
Hallux: Adduction S1 individual is neurologically intact; the ASIA Impairment Scale does not apply.