Patient Name

INTERNATIONAL STANDARDS FOR NEUROLOGICAL CLASSIFICATION OF SPINAL CORD INJURY (ISNCSCI) Date/Time of Exam

Examiner Name Signature

RIGHT MOTOR
KEY MUSCLES
SENSORY
KEY SENSORY POINTS
SENSORY
KEY SENSORY POINTS
MOTOR
KEY MUSCLES LEFT
Light Touch (LTR) Pin Prick Light Touch Pin Prick (PPL)
(PPR) (LTL)
C2 C2 C3 C4
C2 C3
C4 C2

Elbow flexors C5 C3
C5 Elbow flexors
C3

UER Wrist extensors C6 C4

C6 Wrist UEL
extensors
(Upper Extremity C4 T2
(Upper Extremity
Elbow extensors C7 C2 T3
C7 Elbow extensors
Right) T4 C5 Left)
Finger flexors C8 T5 C8 Finger flexors
Finger abductors (little finger) T1 T6
T1 Finger abductors (little finger)
T7
T2 T3 C3 T2
Comments (Non-key Muscle? Reason for NT? C T8
MOTOR
Pain?): T4 T5 C68
T9
C7
T1
T3 (SCORING ON REVERSE SIDE)
C4
T6 T7 Dorsum
Dorsum
T10 C6
T4 0 = total paralysis
T11
T8 T9 T5 1 = palpable or VISIBLE contraction
T12 2 = ACTIVE MOVEMENT, graVITY
T10 L1 T6 eliminated 3 = ACTIVE MOVEMENT,
T11 Palm
T7 against graVITY
4 = ACTIVE MOVEMENT, against some
T12 L1 T8 resistance 5 = ACTIVE MOVEMENT, against full
S3 • Key Sensory resistance 5* = normal corrected for
L2 Points T9 pain/disuse
S4-5 T10 SENSORY
T11 (SCORING ON REVERSE
SIDE) 2 = normal
S2
L3 T12 0 = absent
1= altered NT = not testable
C6
C8 C
C7 C6
8
L1
C7
Hip flexors L2 Dorsum
Dorsum
LER Knee extensors L3 L4
L2 Hip flexors LEL
L3 Knee extensors
(Lower Extremity Ankle dorsiflexors L4 L4 Ankle dorsiflexors (Lower Extremity Left)
Right) S1 L5
Long toe extensors L5 L5 L5 Long toe
extensors
Ankle plantar flexors S1 S1 Ankle plantar flexors
S2 S2
S3 S3
(VAC) Voluntary Anal Contraction S4-5 (DAP) Deep Anal
(Yes/No)
S4-5
Pressure (Yes/No)
RIGHT TOTALS LEFT TOTALS
(MAXIMUM) (MAXIMUM)
MOTOR SUBSCORES SENSORY SUBSCORES
UER + = UEMS LER + = LEMS (56 AL MAX (56)
LTR ) + = LT PP + PPL
MAX UEL (25 TOTAL (50) MAX LEL (25 TOTAL (50) LTL (56) TOT R
MAX (112)
(25) ) (25) )
 (5 6) PP TOTAL (112)
=
NEUROLOGICAL LEVELS R L 3. NEUROLOGICAL LEVEL OF INJURY COMPLETE OR INCOMPLETE? (In complete injuries only) R L
Steps 1-5 for classification as on reverse
SENSORY Incomplete = Any sensory or motor function in S4-5 ZONE OF PARTIAL PRESERVATION SENSORY MOTOR
(NLI) Most caudal level with any innervation
MOTOR ASIA IMPAIRMENT SCALE (AIS)

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
3 = active movement, full ROM against gravity in the sacral segments S4-5. 1. Determine sensory levels for right and left sides.
4 = active movement, full ROM against gravity and moderate resistance in a The sensory level is the most caudal, intact dermatome for both pin prick
muscle specific position B = Sensory Incomplete. Sensory but not motor and light touch sensation.
5 = (normal) active movement, full ROM against gravity and full function is preserved below the neurological level and
resistance in a functional muscle position expected from an otherwise includes the sacral segments S4-5 (light touch or pin prick 2. Determine motor levels for right and left sides.
unimpaired person at S4-5 or deep anal pressure) AND no motor function is Defined by the lowest key muscle function that has a grade of at least
5* = (normal) active movement, full ROM against gravity and sufficient preserved more than three levels below the motor level 3 (on supine testing), providing the key muscle functions represented by
resistance to be considered normal if identified inhibiting factors (i.e. pain, disuse) on either side of the body. segments above that level are judged to be intact (graded as a 5).
Note: in regions where there is no myotome to test, the motor level is
were not present NT = not testable (i.e. due to immobilization, severe pain
such that the patient cannot be graded, amputation of limb, or contracture of > presumed to be the same as the sensory level, if testable motor function
C = Motor Incomplete. Motor function is preserved at above that level is also normal.
50% of the normal ROM) the most caudal sacral segments for voluntary anal contraction
(VAC) OR the patient meets the criteria for sensory
Sensory Grading incomplete status (sensory function preserved at the most
3. Determine the neurological level of injury (NLI)
0 = Absent This refers to the most caudal segment of the cord with intact sensation
caudal sacral segments (S4-S5) by LT, PP or DAP), and and antigravity (3 or more) muscle function strength, provided that there is
1 = Altered, either decreased/impaired sensation or hypersensitivity has some sparing of motor function more than three levels normal (intact) sensory and motor function rostrally respectively.
2 = Normal below the ipsilateral motor level on either side of the body. The NLI is the most cephalad of the sensory and motor levels
NT = Not testable (This includes key or non-key muscle functions to determine determined in steps 1 and 2.
motor incomplete status.) For AIS C – less than half of
When to Test Non-Key Muscles: key muscle functions below the single NLI have a muscle 4. Determine whether the injury is Complete or Incomplete.
In a patient with an apparent AIS B classification, non-key muscle grade ≥ 3. (i.e. absence or presence of sacral sparing)
functions more than 3 levels below the motor level on each side If voluntary anal contraction = No AND all S4-5 sensory scores = 0
should be tested to most accurately classify the injury (differentiate D = Motor Incomplete. Motor incomplete status as AND deep anal pressure = No, then injury is Complete.
between AIS B and C). defined above, with at least half (half or more) of key Otherwise, injury is Incomplete.
Movement Root level
muscle functions below the single NLI having a muscle
grade
C5 ≥ 3.
Shoulder: Flexion, extension, abduction, adduction, internal and external rotation 5. Determine ASIA Impairment Scale (AIS) Grade:
Elbow: Supination Is injury Complete? If YES, AIS=A and can record
E = Normal. If sensation and motor function as tested
Elbow: Pronation C6 with the ISNCSCI are graded as normal in all segments, ZPP (lowest dermatome or myotome
Wrist: Flexion and the patient had prior deficits, then the AIS grade is NO on each side with some preservation)
Finger: Flexion at proximal joint, extension. C7 E. Someone without an initial SCI does not receive an
Thumb: Flexion, extension and abduction in plane of thumb AIS grade.
Is injury Motor Complete? If YES, AIS=B
nger: Flexion at MCP joint C8 Using ND: To document the sensory, motor and NLI NO (No=voluntary anal contraction OR motor function
humb: Opposition, adduction and abduction perpendicular to palm more than three levels below the motor level on
levels, the ASIA Impairment Scale grade, and/or the
a
given side, if the patient has sensory incomplete
Hip: Extension, abduction, internal rotation L4 classification)
Finger: Abduction of the index finger
Knee: Flexion
T1
Ankle:
Hip: Inversion and eversion
Adduction L2
Toe: MP and IP extension Are at least half (half or more) of the key muscles below
Hip: External rotation L3 the neurological level of injury graded 3 or better?
Hallux and Toe: DIP and PIP flexion and abduction L5 NO YES
Hallux: Adduction S1
 INTERNATIONAL STANDARDS FOR
AIS=C AIS=D
NEUROLOGICAL
CLASSIFICATION OF SPINAL CORD INJURY
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 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.

Patient Name Tn. X

INTERNATIONAL STANDARDS FOR NEUROLOGICAL CLASSIFICATION OF SPINAL CORD INJURY (ISNCSCI) Date/Time of Exam

Examiner Name Signature

RIGHT MOTOR
KEY MUSCLES
SENSORY
KEY SENSORY POINTS
SENSORY
KEY SENSORY POINTS KEY MUSCLES
MOTOR LEFT
Light Touch (LTR) Pin Prick Light Touch Pin Prick (PPL)
(PPR) (LTL)
C2 C2 C32 C4
C2 C3 2 2 2
C4 2 2 2
C2
2
Elbow flexors C5 2 2 2 5C5 Elbow flexors
C3 2
5 2 2 2 5
2
5 2 2 C3
2 5
UER Wrist extensors C6
5 2 2
C4 2 C6 Wrist UEL
2 2 5 extensors
5 2 2 C4 2 5
(Upper Extremity
Elbow extensors C7
T2
2 C7 Elbow extensors (Upper Extremity
Right) 5 2 2 C2 T3
C5 2 Left)
Finger flexors C8
T4 2 C8 Finger flexors
2 2 T5
2
2
Finger abductors (little finger) T1 2 2 T6
2 T1 Finger abductors (little finger)
T2 T3 T7 2
2 2 C3
2 T2
Comments (Non-key Muscle? Reason for NT? C T8
2 MOTOR
Pain?): T4 T5 2 2 C68
T9 T1
2 T3 (SCORING ON REVERSE SIDE)
T6 T7 C4
C7
2
2 2 Dorsum
Dorsum
T10 C6
2 T4 0 = total paralysis
T8 T9
T11 2
2 2 2 T5 1 = palpable or VISIBLE contraction
T10
T12 2 2 = ACTIVE MOVEMENT, graVITY
2 2 L1 2 T6 eliminated 3 = ACTIVE MOVEMENT,
2
T11 2 2
Palm
2 T7 against graVITY
2 4 = ACTIVE MOVEMENT, against some
T12 L1 2 2 2 T8 resistance 5 = ACTIVE MOVEMENT, against full
S3 • Key Sensory 2 resistance 5* = normal corrected for
2 2 L2 Points 2 T9
2 pain/disuse
2 2 S4-5
0 T10 SENSORY
2
0 0 0 T11 (SCORING ON REVERSE
2 SIDE) 2 = normal
0 0 L3 0 T12 0 = absent
S2 0 1= altered NT = not testable
0 0 C8 C
0 L1
C6 C7 C6
8 0
0 0 0 C7
0
Hip flexors L2 Dorsum
0
0 0 0 Dorsum
0 0L2 Hip flexors
LER Knee extensors L3 L4 0 LEL
0 0 0 0 0L3 Knee extensors
0
0 0 0 0 0
(Lower Extremity Ankle dorsiflexors L4 0 0
0
0 L4 Ankle dorsiflexors (Lower Extremity Left)
Right) 0 S1 L5 0
Long toe extensors L5 L5 0 L5 Long toe
0 0 0 0
0 extensors
0
Ankle plantar flexors S1 ( 0 /
Y
0
N S2 S3 S4-5
e o
(VAC) Voluntary Anal Contraction N s )
 S1 ar
S2 S3 S4-5 Ankle flexor
NO (DAP) Deep Anal
plant s
Pressure (Yes/No)
RIGHT TOTALS 25 38 25 LEFT TOTALS
(MAXIMUM) (MAXIMUM)
MOTOR SUBSCORES SENSORY SUBSCORES
25 25 0 0 38 38
38 38
UER + = UEMS LER + = LEMS
50 0 LTR + = LT 76 PPR + = PP 76
MAX UEL (25 TOTAL MAX LEL (25 TOTAL LTL TOTAL PPL TOTAL
(25) (50) MAX (56) MAX (56
) (25) ) (50) (56) (56) )
(112) (112)
NEUROLOGICAL LEVELS R L 3. NEUROLOGICAL LEVEL OF INJURY COMPLETE OR INCOMPLETE? (In complete injuries only) R L
Steps 1-5 for classification as on reverse
SENSORY T12 T12 Incomplete = Any sensory or motor function in S4-5
C
ZONE OF PARTIAL PRESERVATION
SENSORY MOTOR
(NLI) L2
Most caudal level with any innervation
MOTOR L2 L2
ASIA IMPAIRMENT SCALE (AIS) A