American Spinal Injury Association

class="wikitable floatright" \|+ Muscle strength score{{sfn\|Harvey\|2008\|p=7}} ! style="text-align:center;background-color:#ffc0c0;" \| Grade ! style="text-align:center;background-color:#ffc0c0;" \| Muscle function
0 \|No muscle contraction
1 \| Muscle flickers
2 \| Full range of motion with gravity eliminated
3 \| Full range of motion against gravity
4 \| Full range of motion against resistance
5 \| Normal strength

class="wikitable floatright"

|+ Muscle strength score{{sfn|Harvey|2008|p=7}}

! style="text-align:center;background-color:#ffc0c0;" | Grade

! style="text-align:center;background-color:#ffc0c0;" | Muscle function

|No muscle contraction

| Muscle flickers

| Full range of motion with gravity eliminated

| Full range of motion against gravity

| Full range of motion against resistance

| Normal strength

The American Spinal Injury Association (ASIA), formed in 1973,{{Cite web |url=http://www.asia-spinalinjury.org/about/history.php |title=ASIA | History |access-date=2016-01-05 |archive-url=https://web.archive.org/web/20160123071147/http://asia-spinalinjury.org/about/history.php |archive-date=2016-01-23 |url-status=dead }} publishes the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), which is a neurological exam widely used to document sensory and motor impairments following spinal cord injury (SCI). The ASIA assessment is the gold standard for assessing SCI.{{sfn|Dimitrijevic et al.|2012|p=12}} ASIA is one of the affiliated societies of the International Spinal Cord Society.[http://www.iscos.org.uk/affiliated-societies Affiliated Societies] 13.04.2011

The exam is based on neurological responses, touch and pinprick sensations tested in each dermatome, and strength of the muscles that control key motions on both sides of the body. Muscle strength is scored on a scale of 0–5 according to the adjacent table, and sensation is graded on a scale of 0–2: 0 is no sensation, 1 is altered or decreased sensation, and 2 is full sensation.{{sfn|Weiss|2010|p=307}} Each side of the body is graded independently.{{sfn|Weiss|2010|p=307}} When an area is not available (e.g. because of an amputation or cast), it is recorded as "NT", "not testable". The ISNCSCI exam is used for determining the neurological level of injury (the lowest area of full, uninterrupted sensation and function).

The completeness or incompleteness of the injury is measured by the ASIA Impairment Scale (AIS).

class="wikitable" style="width: 100%; float: right;" \|+ASIA Impairment Scale for classifying spinal cord injury{{sfn\|Teufack\|Harrop\|Ashwini\|2012\|p=67}} ! style="text-align:center;background-color:#ffc0c0;" \| Grade ! style="text-align:center;background-color:#ffc0c0;" \| Description
A \|Complete injury. No motor or sensory function is preserved in the sacral segments S4 or S5.
B \|Sensory incomplete. Sensory but not motor function is preserved below the level of injury, including the sacral segments.
C \|Motor incomplete. Motor function is preserved below the level of injury, and more than half of muscles tested below the level of injury have a muscle grade less than 3 (see muscle strength scores table).
D \|Motor incomplete. Motor function is preserved below the level of injury and at least half of the key muscles below the neurological level have a muscle grade of 3 or more.
E \|Normal. No motor or sensory deficits, but deficits existed in the past.

class="wikitable" style="width: 100%; float: right;"

|+ASIA Impairment Scale for classifying spinal cord injury{{sfn|Teufack|Harrop|Ashwini|2012|p=67}}

! style="text-align:center;background-color:#ffc0c0;" | Grade

! style="text-align:center;background-color:#ffc0c0;" | Description

|Complete injury. No motor or sensory function is preserved in the sacral segments S4 or S5.

|Sensory incomplete. Sensory but not motor function is preserved below the level of injury, including the sacral segments.

|Motor incomplete. Motor function is preserved below the level of injury, and more than half of muscles tested below the level of injury have a muscle grade less than 3 (see muscle strength scores table).

|Motor incomplete. Motor function is preserved below the level of injury and at least half of the key muscles below the neurological level have a muscle grade of 3 or more.

|Normal. No motor or sensory deficits, but deficits existed in the past.

History

Until the development of the Frankel grade classification (FGC) in 1969, there was no universally accepted grading system for SCI. Frankel and his team developed a classification system with five grades, labeled A through E, to assess the severity of neurological impairments following a traumatic SCI.{{Cite journal |last=Kirshblum |first=Steven |last2=Botticello |first2=Amanda |last3=Benedetto |first3=John |last4=Donovan |first4=Jayne |last5=Marino |first5=Ralph |last6=Hsieh |first6=Shelly |last7=Wagaman |first7=Nicole |date=2020-06-09 |title=A Comparison of Diagnostic Stability of the ASIA Impairment Scale Versus Frankel Classification Systems for Traumatic Spinal Cord Injury |url=https://linkinghub.elsevier.com/retrieve/pii/S000399932030366X |journal=Archives of Physical Medicine and Rehabilitation |language=en |volume=101 |issue=9 |pages=1556–1562 |doi=10.1016/j.apmr.2020.05.016}}

In 1982, the Standards Committee of ASIA revised and published the first edition of the "Standards for Neurologic Classification of Spinal Cord Injury," based on the modified version of the FGC.

References

{{Reflist|refs=

{{cite web|title=Standard Neurological Classification of Spinal Cord Injury |url=http://www.asia-spinalinjury.org/publications/59544_sc_Exam_Sheet_r4.pdf |publisher=American Spinal Injury Association & ISCOS |access-date=5 November 2015 |url-status=dead |archive-url=https://web.archive.org/web/20110618124126/http://www.asia-spinalinjury.org/publications/59544_sc_Exam_Sheet_r4.pdf |archive-date=June 18, 2011 }}

{{cite journal|last1=Kirshblum|first1=Steven C.|last2=Burns|first2=Stephen P.|last3=Biering-Sorensen|first3=Fin|last4=Donovan|first4=William|last5=Graves|first5=Daniel E.|last6=Jha|first6=Amitabh|last7=Johansen|first7=Mark|last8=Jones|first8=Linda|last9=Krassioukov|first9=Andrei|last10=Mulcahey|first10=M.J.|last11=Schmidt-Read|first11=Mary|last12=Waring|first12=William|title=International standards for neurological classification of spinal cord injury (Revised 2011)|journal=The Journal of Spinal Cord Medicine|volume=34|issue=6|year=2011|pages=535–546|issn=1079-0268|doi=10.1179/204577211X13207446293695|pmc=3232636|pmid=22330108}}

{{cite journal |pmid=16296564 |year=2003 |last1=Marino |first1=R.J. |last2=Barros |first2=T. |last3=Biering-Sorensen |first3=F. |last4=Burns |first4=S.P. |last5=Donovan |first5=W.H. |last6=Graves |first6=D.E. |last7=Haak |first7=M. |last8=Hudson |first8=L.M. |last9=Priebe |first9=M.M. |author10=ASIA Neurological Standards Committee 2002 |title=International standards for neurological classification of spinal cord injury |volume=26 Suppl 1 |pages=S50–56 |journal=The Journal of Spinal Cord Medicine |doi=10.1080/10790268.2003.11754575|s2cid=12799339 }}

}}

Bibliography

{{cite book |ref={{sfnref|Dimitrijevic et al.|2012}} |editor1-last=Dimitrijevic |editor1-first=Milan R. |editor2-last=Kakulas |editor2-first=Byron A. |editor3-last=McKay |editor3-first=W. Barry |editor4-last=Vrbová |editor4-first=Gerta |title=Restorative Neurology of Spinal Cord Injury |url=https://books.google.com/books?id=v17YJZjF0CgC&pg=PA12 |date=12 January 2012 |publisher=Oxford University Press, USA |isbn=978-0-19-974650-7}}
{{cite book | vauthors = Harvey L |title=Management of Spinal Cord Injuries: A Guide for Physiotherapists |url=https://books.google.com/books?id=FujsWb3H2UEC&pg=PA30 |year=2008 |publisher=Elsevier Health Sciences |isbn=978-0-443-06858-4 }}
{{cite book | vauthors = Teufack S, Harrop JS, Ashwini DS | veditors = Fehlings MG, Vaccaro AR, Maxwell B |chapter=Spinal Cord Injury Classification |title=Essentials of Spinal Cord Injury: Basic Research to Clinical Practice |chapter-url=https://books.google.com/books?id=aQC-sQOCzhQC |date=29 October 2012 |publisher=Thieme |isbn=978-1-60406-727-9}}
{{cite book |last1=Weiss |first1=J.M. |chapter=Spinal cord injury |editor=Weiss, L.D. |editor2=Weiss, J.M. |editor3=Pobre, T. |title=Oxford American Handbook of Physical Medicine and Rehabilitation |url=https://books.google.com/books?id=aFuYCAiW0hsC |date=15 March 2010 |publisher=Oxford University Press, USA |isbn=978-0-19-970999-1}}

External links

[http://www.asia-spinalinjury.org/ American Spinal Injury Association] homepage

Category:Disability organizations based in the United States

Category:Surgical organizations based in the United States

Category:Neurotrauma