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C5 Elbow flexors
Elbow flexors C5
RIGHT MOTOR
LEFT
C3
KEY SENSORYC4POINTS
MOTOR
KEY SENSORY POINTS
Wrist extensors C6 KEY MUSCLES
INTERNATIONAL STANDARDS Light
FORTouch (LTR) Pin Prick (PPR)
NEUROLOGICAL Patient Name_____________________________________ C6 Wrist extensors
Light Touch (LTL) Pin Prick (PPL) Date/Time of UEL
KEY MUSCLES
Exam _____________________________
Elbow extensors C7 T3
T2
C7 Elbow extensors (Upper Extremity Left)
CLASSIFICATION OF SPINAL C2 CORD INJURY
C2
C8 Finger flexorsC2Signature _____________________________________
C5
Finger flexors C8 0 = absent T4
Examiner Name ___________________________________
(ISNCSCI)C3 T5 C3 (little finger)
bductors (little finger) T1 2 = normal
1 = 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?): Elbow flexors C5 KEY
C3
SENSORY T8
POINTS C3 KEY SENSORY POINTS MOTOR C5 Elbow flexors
T3 KEY MUSCLES T9 T1 T3 (SCORING ON KEY MUSCLES
REVERSE SIDE)
UER UEL
0 = absent
Wrist extensors C6 Light 1Touch
= (LTR)
altered Pin Prick (PPR) C4 Light Touch (LTL) Pin Prick (PPL) C6 Wrist extensors
C4
(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 T1 Finger abductors (little finger)
4 = active movement, against some resistance
ltered
T7 T7 T7
ormal
C5 T2
NT = not testable C3 5 = active movement, T2
against full
C5 Elbow flexors
resistance
not testable Comments (Non-key Muscle? Reason for NT? Pain?):
T8
C3 T8
T8 5* = normal corrected for pain/disuse MOTOR
UER C6 T3 S3 C4
T9 T1 NT = not testable T3 C6 ON REVERSE SIDE) UEL
Wrist extensors
(SCORING
•
0 = absent
This form may be copied freely but should not be altered without permission from the American Spinal Injury Association. REV 04/15
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 = a ctive 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.