American Spinal Injury Association

The American Spinal Injury Association (ASIA), formed in 1973,[2] publishes the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI),[3] which is a neurological exam widely used to document sensory and motor impairments following spinal cord injury (SCI).[4] The ASIA assessment is the gold standard for assessing SCI.[5] ASIA is one of the affiliated societies of the International Spinal Cord Society.[6]

Muscle strength score[1]
Grade 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

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.[7] 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.[8] Each side of the body is graded independently.[8] When an area is not available (e.g. because of an amputation or cast), it is recorded as "NT", "not testable".[3] The ISNCSCI exam is used for determining the neurological level of injury (the lowest area of full, uninterrupted sensation and function).[3]

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

ASIA Impairment Scale for classifying spinal cord injury[7][9]
Grade 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.

References
  1. Harvey 2008, p. 7.
  2. "Archived copy". Archived from the original on 2016-01-23. Retrieved 2016-01-05.CS1 maint: archived copy as title (link)
  3. Kirshblum, Steven C.; Burns, Stephen P.; Biering-Sorensen, Fin; Donovan, William; Graves, Daniel E.; Jha, Amitabh; Johansen, Mark; Jones, Linda; Krassioukov, Andrei; Mulcahey, M.J.; Schmidt-Read, Mary; Waring, William (2011). "International standards for neurological classification of spinal cord injury (Revised 2011)". The Journal of Spinal Cord Medicine. 34 (6): 535–546. doi:10.1179/204577211X13207446293695. ISSN 1079-0268. PMC 3232636.
  4. Marino, R.J.; Barros, T.; Biering-Sorensen, F.; Burns, S.P.; Donovan, W.H.; Graves, D.E.; Haak, M.; Hudson, L.M.; Priebe, M.M.; ASIA Neurological Standards Committee 2002 (2003). "International standards for neurological classification of spinal cord injury". The journal of spinal cord medicine. 26 Suppl 1: S50–56. doi:10.1080/10790268.2003.11754575. PMID 16296564.
  5. Dimitrijevic et al. 2012, p. 12.
  6. Affiliated Societies 13.04.2011
  7. "Standard Neurological Classification of Spinal Cord Injury" (PDF). American Spinal Injury Association & ISCOS. Archived from the original (PDF) on June 18, 2011. Retrieved 5 November 2015.
  8. Weiss 2010, p. 307.
  9. Teufack, Harrop & Ashwini 2012, p. 67.

Bibliography
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