INTERNATIONAL STANDARDS FOR NEUROLOGICAL CLASSIFICATION OF

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

RIGHT C6 UER C4 (ISNCSCI) C4 C6 UEL LEFT C3 Light Touch (LTL

This form may be copied freely but should not be altered without permission from the American Spinal Injury Association REV 02/13 RIGHT UER (Upper Extremity Right) T2 T3 T4 T5 T6 T7 T8 T10 T11 T12 L1 LER (Lower Extremity Right) S2 S3 S4-5 MOTOR KEY MUSCLES SENSORY Light Touch (LTL) Pin Prick (PPL) LEFT UEL (Upper Extremity Left) T2 T3 T4 T5 T7

Living with Spinal Cord Injury - United Spinal Association

This form may be copied freely but should not be altered without permission from the American Spinal Injury Association REV 02/13 RIGHT UER (Upper Extremity Right) T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 L1 LER (Lower Extremity Right) S2 S3 S4-5 MOTOR KEY MUSCLES SENSORY Light Touch (LTL) Pin Prick (PPL) LEFT UEL (Upper Extremity Left) T2 T3 T4 T5

ROBOTIC TRAINING AND ClINICAl ASSESSMENT OF UPPER ExTREMITy

Right left 7 18 9 19 ARAT (0–57) Right left 3 41 3 49 JTHFT (total time, s) Right left 1,080 151 64 1,080 80 4 ASIA: American Spinal Injury Association; ARAT: Action Research Arm Test, JTHFT: Jebsen-Taylor Hand Function Test The JTHFT was ended after 180 s lower times represent better performance Fig 1 Training with the MAHI Exo-II

INTERNATIONAL STANDARDS FOR NEUROLOGICAL CLASSIFICATION OF

Elbow flexorsRIGHT C4 Elbow flexors LEFT Wrist extensors C6

Dermatomes Anatomy Overview

level of spinal cord injury in the American Spinal Injury Association (ASIA) Impairment scale [2] Gross Anatomy Basic anatomy, dorsal (sensory) roots The cell bodies of sensory neurons of spinal nerves are located in the dorsal root ganglia [3, 4, 5] Each dorsal root contains the input from all the structures within the

Right-Sided and Posterior Electrocardiograms (ECGs)

Occlusion of the right coronary artery proximal to the right ventricular branch is associated with inferior wall MI involving the RV1-3,5,8-9,11,16 In approximately 10 of the population, the left circumflex artery supplies the right ventricle and may therefore cause an associated lateral wall MI in conjunction with the RV infarction5,8

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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

as on reverse

1. SENSO

RY 2. MO TOR

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

SENSO RY MO TOR

R L

MOTOR SUBSCORES SENSORY SUBSCORES

UER+UEL= UEMS TOTAL

LER+ LEL= LEMS TOTALPPR+ PPL= PP TOTALLTR+ LTL= LT TOTAL (50)(56)(56)

RIGHT TOTALS

(MAXIMUM)(56)(56)(50)

LEFT TOTALS

(MAXIMUM)(VAC) Voluntary Anal Contraction

Yes/No)(DAP) Deep Anal Pressure

Yes/No)

C5 C6 C7 C8 T1C5 C6 C7 C8 T1 L2 L3 L4 L5

S1L2L3L4L5S1C2C3

C4 S2 S3

S4-5T2

T3 T4 T5 T6 T7 T8 T9 T10 T 11 T12 L1C2 C3 C4 S2 S3

S4-5T2T3T4T5

T6 T7 T8 T9 T10 T 11 T12 L1

RIGHTLEFT

UER (Upper Extremity Right) LER (Lower Extremity Right) UEL (Upper Extremity Left) LEL (Lower Extremity Left)

Wrist extensors

Elbow extensors

Knee extensors

Long toe extensors

Wrist extensors

Elbow extensors

Knee extensors

Long toe extensors

Pin Prick (PPR)Light Touch (LTR)Pin Prick (PPL)Light Touch (LTL) SE NSO RY

KEY SENSORY POINTS

SE NSO RY

KEY SENSORY POINTS

MO TOR KE

Y MUSCLES

MO TOR KE

Y MUSCLES

0 =

Absent

1 =

Altered

2 = NormalNT = Not testable

0, 1, NT* = Non-SCI

condition present SENSO RY (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

T = Not testable

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

MO TOR (SCORING ON REVERSE SIDE)Comments (Non-key Muscle? Reason for NT? Pain?

Non-SCI condition?):

CLASSIFICATION OF SPINAL CORD INJURY

(ISNCSCI)

Patient NameDate/Time of Exam

Examiner Name Signature

INTERNATIONAL STANDARDS FOR NEUROLOGICAL

C2 C3 C4

C6T1C5

L1 L2 L3 L4

L5Palm

Key Sensory

Points

S4-5S3

S2 S1 L5 L4L 3L 2 C2 C3 C4 T3 T2 T4 T5 T6 T7 T8 T9 T10 T 11 T12

C8C7C6

Dorsum

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

D = Motor Incomplete. Motor incomplete status as

E = Normal. f sensation and motor function as tested with the ISNCSCI are graded as normal in all segments, and the 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)

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

5 = (Normal) active movement, full ROM against gravity and full resistan

ce in a functional muscle position expected from an otherwise unimpaired person NT = Not testable (i.e. due to immobilization, severe pain such that the p atient cannot be graded, amputation of limb, or contracture of > 50% of the nor mal 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

a most accurately classify the injury (differentiate between AIS B and C). individuals with SCI.

INTERNATIONAL STANDARDS FOR NEUROLOGICAL

CLASSIFICATION OF SPINAL CORD INJURY

Movement

Shoulder: Flexion, extension, adbuction, adduction, internal and external rotation

[PDF] INTERNATIONAL STANDARDS FOR NEUROLOGICAL CLASSIFICATION OF

REV 04/19Page 1/2

NEUROLOGICAL

LEVELS

1. SENSO

R L

3. NEUROLOGICAL

LEVEL OF INJURY

4. COMPLETE OR INCOMPLETE?

Incomplete =

Any sensory or motor function in S4-5

5. ASIA IMPAIRMENT SCALE (AIS)

6. ZONE OF PARTIAL

PRESERVATION

Most caudal levels with any innervation

R L

MOTOR SUBSCORES SENSORY SUBSCORES

UER+UEL= UEMS TOTAL

RIGHT TOTALS

LEFT TOTALS

Yes/No)(DAP) Deep Anal Pressure

Yes/No)

S1L2L3L4L5S1C2C3

S4-5T2

S4-5T2T3T4T5

RIGHTLEFT

Wrist extensors

Elbow extensors

Knee extensors

Long toe extensors

Wrist extensors

Elbow extensors

Knee extensors

Long toe extensors

KEY SENSORY POINTS

KEY SENSORY POINTS

Y MUSCLES

Y MUSCLES

Absent

Altered

2 = NormalNT = Not testable

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

Total paralysis

1 = Palpable or visible contraction

Active movement, gravity eliminated

Active movement, against gravity

Active movement, against some resistance

Active movement, against full resistance

T = Not testable

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

Non-SCI condition?):

CLASSIFICATION OF SPINAL CORD INJURY

Patient NameDate/Time of Exam

Examiner Name Signature

INTERNATIONAL STANDARDS FOR NEUROLOGICAL

C6T1C5

L5Palm

Key Sensory

Points

S4-5S3

C8C7C6

Dorsum

Page 2/2

D = Motor Incomplete. Motor incomplete status as

ASIA Impairment Scale (AIS)

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

5 = (Normal) active movement, full ROM against gravity and full resistan

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

INTERNATIONAL STANDARDS FOR NEUROLOGICAL

CLASSIFICATION OF SPINAL CORD INJURY

0, 1, NT* = Non-SCI

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

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

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