SENSORY SENSORY

C5 Elbow flexors
Elbow flexors C5
RIGHT MOTOR
LEFT
C3
KEY SENSORYC4POINTS
MOTOR
KEY SENSORY POINTS
Wrist extensors C6 KEY MUSCLES
INTERNATIONAL STANDARDS FOR NEUROLOGICAL Light Touch (LTR) Pin Prick (PPR) Patient Name_____________________________________ C6 Wrist extensors Date/Time
Light Touch (LTL) Pin Prick (PPL)
KEY MUSCLES
of UEL
Exam _____________________________
Elbow extensors C7 T3
T2
C7 Elbow extensors (Upper Extremity Left)
CLASSIFICATION OF SPINAL C2 CORD INJURY
C2
C8 Finger flexorsC2Signature _____________________________________
T4 C5
Finger flexors C8 0 = absent (ISNCSCI)
Examiner Name ___________________________________
C3 T5 C3 (little finger)
bductors (little finger) T1 21 == normal
altered
T6 T1 Finger abductors C4
C4 SENSORY SENSORY
RIGHT LEFT
T7 C2
T2
NT = not testable
MOTOR T2 MOTOR
cle? Reason for NT? Pain?): C5
C3 T8 MOTOR C5 Elbow flexors
T3 Elbow flexors
KEY SENSORY POINTS C3 KEY SENSORY POINTS
KEY MUSCLES 0 = absent T9 T1 T3 (SCORING ON REVERSEKEY MUSCLES
SIDE)
UER Wrist extensors C6 Light Touch (LTR)
1 = altered
C4
Pin Prick (PPR) C4 Light Touch (LTL) Pin Prick (PPL) C6 Wrist extensors UEL
(Upper Extremity Right) T4 2 = normal T10 C6
T2 T4 0 = total paralysis (Upper Extremity Left)
Elbow extensors C7 C2 NT = not testable T11 T3 C2 C7 Elbow extensors
T5 C2
T4 C5 T5 1 = palpable or visible contraction
Finger flexors C8 0 = absentC3 T12 C3 eliminated
2 = active movement, gravity C8 Finger flexors
T6 T5 T6 3 = active movement, against gravity
bsent Finger abductors (little finger) T1 21 == normal C4
altered L1
Palm T6
C2 C4 some resistance
4 = active movement, against T1 Finger abductors (little finger)
ltered
T7 T7 T7
ormal
Elbow flexors C5 T2
NT = not testable C3 5 = active movement, T2
against full resistance
C5 Elbow flexors
not testable Comments (Non-key Muscle? Reason for NT? Pain?):
T8
C3 T8
T8 5* = normal corrected for pain/disuse MOTOR
UER Wrist extensors C6 T3 S3 0 = absent C4
T9 T1 NT = not testable T3 C6 (SCORING ON REVERSE SIDE) UEL
Wrist extensors
(Upper Extremity Right) T9 Elbow extensors
C7 T4 L2 21Key Sensory
= altered
C4
= normal
C2
T10
T3
T2 C6 T9 T4 C7 Elbow
0 = total extensors
paralysis (Upper Extremity Left)
T10 Finger flexors
S4-5 NT Points T11
= not testable T4 C5 T10 SENSORY
T5
C8 0 = absentT5
1 = palpable or visible contraction
T11 (SCORING ON REVERSEC8 2SIDE) Finger
= active flexorsgravity eliminated
movement,
T11 T6
T12
T5
T6 T1
Finger abductors (little finger) T1 2 = normal
1 = altered T6 L1 3 = Finger
active abductors
movement, against(little
gravity
finger)
0 = absent
T12 NT = not T7
T7 Palm T12 0 = absent
T7
2 = normal
4 = active movement, against some resistance
1 = altered
T2
testable
S2 L3
8
C3 C 6 C 8 1= altered T2 NT = not testable
5 = active movement, against full resistance
2 = normal
L1= not testable
Comments (Non-key Muscle? Reason for NT? Pain?): C6 C
T8
L1 T8 MOTOR
NT
T8
T3 C7 C7
0 = absent T9 T1 T3 5* = normal corrected
(SCORING
for pain/disuse
ON REVERSE SIDE)
1 S3 NT = not testable
Hip flexors L2 T9
T4 Dorsum =DorsumC4
altered
2 = normal T10 L2 Key Sensory
C6 L2 Hip flexors T9
T4 0 = total paralysis
Knee extensors L3
T11
T10
T5
S4-5
NT = not testable Points L3 Knee extensors T10
T5 1 = palpable or SENSORY
visible contraction
L4 T12 LEL
2 = active movement,ONgravity eliminated
Ankle dorsiflexors L4 T11
T6 L1 L4 T11 (Lower
T6
Ankle dorsiflexors
(SCORING
Extremity
3 = active movement, Left)
REVERSE
against gravity
SIDE)
0 = absent L5
ong toe extensors L5 1 = altered T12
T7 L3
Palm
L5 Long toe extensors T12
T7 40 =
= absent
active movement, against 2 =
some normal
resistance
NT resistance
= not testable
2 = normal S2 C8 6 C8 51==altered
active movement, against full
S1 Ankle plantar L1
S1
nkle plantar flexors S1 NT = not testable L1 L5
T8 C 6 C
C7 C7 T8
flexors 5* = normal corrected for pain/disuse
S2 Hip flexors L2 T9
S3
L2 Dorsum S2
Key
Dorsum Sensory T9
NT = not testable
L2 Hip flexors
Points
S3 Knee extensors L3 T10 S4-5
S3 T10 L3 Knee extensors SENSORY
raction LER L4 (DAP) Deep anal(SCORING pressureON REVERSE SIDE) LEL
S4-5
Yes/No) (Lower Extremity Right) Ankle dorsiflexors L4 T11 S4-5 T11
L5 (Yes/No) L4 Ankle dorsiflexors (Lower Extremity Left)
Long toe extensors L5 T12 S2 L3 T12 0 = absent
L5 Long
1= altered toe extensors
2 = normal
NT = not testable
RIGHT TOTALS Ankle plantar flexors S1 L1 S1 C8 6 C8 LEFT TOTALS L1
L5 C6 C
C7 C7 S1 Ankle plantar flexors
(MAXIMUM) (MAXIMUM)
Hip flexors L2 S2 Dorsum Dorsum S2 L2 Hip flexors
S SENSORY SUBSCORES
L3 S3 S3 L3 Knee extensors
= UEMS TOTAL LER anal contraction
(VAC) Voluntary
LER
Knee extensors
+ LEL L4 = LEMS TOTAL
S4-5 LTR + LTL L4
= LT TOTAL PPR + PPL S4-5 = PP TOTAL
(DAP) Deep anal pressure LEL
(Yes/No)
(Lower Extremity Right) Ankle dorsiflexors L5
L4 Ankle dorsiflexors
(Yes/No) (Lower Extremity Left)
(50) MAX (25) (25) (50)
Long toe extensors L5 MAX (56) (56) (112) MAX (56) (56)
L5LEFT Long toe (112)
TOTALS extensors
RIGHT TOTALS S1
R L Ankle plantar flexors S1 L5
4. COMPLETE OR INCOMPLETE? (In complete injuries only) S1 Ankle
R
(MAXIMUM) 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)

NEUROLOGICAL R L 3. NEUROLOGICAL 4. COMPLETE OR INCOMPLETE? (In complete injuries only) R L

LEVELS 1. SENSORY Incomplete = Any sensory or motor function in S4-5 ZONE OF PARTIAL SENSORY
LEVEL OF INJURY
Steps 1-5 for classification
2. MOTOR (NLI) 5. ASIA IMPAIRMENT SCALE (AIS) PRESERVATION MOTOR
as on reverse 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.
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 = 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 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.