Elbow flexorsRIGHT C4 Elbow flexors LEFT Wrist extensors ...

1 0 = absent1 = altered2 = normalNT = not testable0 = absent1 = altered2 = normalNT = not testableC2C3C4S3S2L5S1L5L4L3L2L1T12T11T1 0T9T8T7T6T5T4T3C4C3C2T2C5T1C6 PalmDorsumC6C8C70 = absent1 = altered2 = normalNT = not testableDorsumC6C8C7S4-5 Key Sensory Points0 = absent1 = altered2 = normalNT = not testable0 = absent1 = altered2 = normalNT = not testableC2C3C4S3S2L5S1L5L4L3L2L1T12T11T1 0T9T8T7T6T5T4T3C4C3C2T2C5T1C6 PalmDorsumC6C8C70 = absent1 = altered2 = normalNT = not testableDorsumC6C8C7S4-5 Key Sensory PointsC5C6C7C8T1L2L3L4L5S1 MOTORKEY MUSCLESSENSORY KEY SENSORY POINTS Pin Prick (PPR)Light Touch (LTR)(VAC) Voluntary anal contraction (Yes/No)Comments (Non-key Muscle? Reason for NT? Pain?):NEUROLOGICAL LEVELSS teps 1-5 for classification as on reverse1.

2 SENSORY 2. MOTOR R L 3. NEUROLOGICAL LEVEL OF INJURY(NLI)4. COMPLETE OR INCOMPLETE?Incomplete = Any sensory or motor function in S4-55. ASIA IMPAIRMENT SCALE (AIS)(In complete injuries only)ZONE OF PARTIALPRESERVATIONMost caudal level with any innervationSENSORY MOTOR R LREV 02/13 This form may be copied freely but should not be altered without permission from the American Spinal Injury (Upper Extremity Right)T2T3T4T5T6T7T8T9T10T11T12L1 LER(Lower Extremity Right)S2S3S4-5 MOTORKEY MUSCLESSENSORY KEY SENSORY POINTSPin Prick (PPL)Light Touch (LTL)LEFTUEL(Upper Extremity Left)T2T3T4T5T6T7T8T9T10T11T12L1 LEL(Lower Extremity Left) S2S3S4-5 Elbow flexorsWrist extensorsElbow extensorsFinger flexorsFinger abductors (little finger) Hip flexorsKnee extensorsAnkle dorsiflexorsLong toe extensorsAnkle plantar flexorsC2C3C4C2C3C4(DAP)

3 Deep anal pressure (Yes/No)UER + UEL= UEMS TOTAL(25)(25)(50)MOTOR SUBSCORES MAXLER + LEL= LEMS TOTAL(25)(25)(50)MAXLTR + LTL = LT TOTAL(56)(56)(112)MAXSENSORY SUBSCORES MAXPPR + PPL= PP TOTAL(56)(56)(112)4 = active movement, against some resistance 5 = active movement, against full resistance5* = normal corrected for pain/disuseNT = not testableMOTOR(SCORING ON REVERSE SIDE) 0 = total paralysis 1 = palpable or visible contraction 2 = active movement, gravity eliminated 3 = active movement, against gravityElbow flexorsWrist extensorsElbow extensorsFinger flexorsFinger abductors (little finger) Hip flexorsKnee extensorsAnkle dorsiflexorsLong toe extensorsAnkle plantar flexorsRIGHT TOTALS (MAXIMUM)C5C6C7C8T1L2L3L4L5S1 LEFT TOTALS(MAXIMUM)SENSORY(SCORING ON REVERSE SIDE)0 = absent1= altered2 = normalNT = not testableINTERNATIONAL STANDARDS FOR NEUROLOGICAL CLASSIFICATION OF SPINAL CORD INJURY(ISNCSCI)Patient Name_____ Date/Time of Exam _____Examiner Name _____ Signature _____ 0 = absent1 = altered2 = normalNT = not testable0 = absent1 = altered2 = normalNT = not testableC2C3C4S3S2L5S1L5L4L3L2L1T12T11T1 0T9T8T7T6T5T4T3C4C3C2T2C5T1C6 PalmDorsumC6C8C70 = absent1 = altered2 = normalNT = not testableDorsumC6C8C7S4-5 Key Sensory PointsC5C6C7C8T1L2L3L4L5S1 MOTORKEY MUSCLESSENSORY KEY SENSORY POINTS Pin Prick (PPR)Light Touch (LTR)(VAC) Voluntary anal contraction (Yes/No)Comments (Non-key Muscle?)

4 Reason for NT? Pain?):NEUROLOGICAL LEVELSS teps 1-5 for classification as on reverse1. SENSORY 2. MOTOR R L 3. NEUROLOGICAL LEVEL OF INJURY(NLI)4. COMPLETE OR INCOMPLETE?Incomplete = Any sensory or motor function in S4-55. ASIA IMPAIRMENT SCALE (AIS)(In complete injuries only)ZONE OF PARTIALPRESERVATIONMost caudal level with any innervationSENSORY MOTOR R LREV 02/13 This form may be copied freely but should not be altered without permission from the American Spinal Injury (Upper Extremity Right)T2T3T4T5T6T7T8T9T10T11T12L1 LER(Lower Extremity Right)S2S3S4-5 MOTORKEY MUSCLESSENSORY KEY SENSORY POINTSPin Prick (PPL)Light Touch (LTL)LEFTUEL(Upper Extremity Left)T2T3T4T5T6T7T8T9T10T11T12L1 LEL(Lower Extremity Left) S2S3S4-5 Elbow flexorsWrist extensorsElbow extensorsFinger flexorsFinger abductors (little finger) Hip flexorsKnee extensorsAnkle dorsiflexorsLong toe extensorsAnkle plantar flexorsC2C3C4C2C3C4(DAP)

5 Deep anal pressure (Yes/No)UER + UEL= UEMS TOTAL(25)(25)(50)MOTOR SUBSCORES MAXLER + LEL= LEMS TOTAL(25)(25)(50)MAXLTR + LTL = LT TOTAL(56)(56)(112)MAXSENSORY SUBSCORES MAXPPR + PPL= PP TOTAL(56)(56)(112)4 = active movement, against some resistance 5 = active movement, against full resistance5* = normal corrected for pain/disuseNT = not testableMOTOR(SCORING ON REVERSE SIDE) 0 = total paralysis 1 = palpable or visible contraction 2 = active movement, gravity eliminated 3 = active movement, against gravityElbow flexorsWrist extensorsElbow extensorsFinger flexorsFinger abductors (little finger) Hip flexorsKnee extensorsAnkle dorsiflexorsLong toe extensorsAnkle plantar flexorsRIGHT TOTALS (MAXIMUM)C5C6C7C8T1L2L3L4L5S1 LEFT TOTALS(MAXIMUM)SENSORY(SCORING ON REVERSE SIDE)0 = absent1= altered2 = normalNT = not testableINTERNATIONAL STANDARDS FOR NEUROLOGICAL CLASSIFICATION OF SPINAL CORD INJURY(ISNCSCI)Patient Name_____ Date/Time of Exam _____Examiner Name _____ Signature _____ C5C6C7C8T1L2L3L4L5S1 MOTORKEY MUSCLESSENSORY KEY SENSORY POINTS Pin Prick (PPR)Light Touch (LTR)(VAC) Voluntary Anal Contraction (Yes/No)Comments (Non-key Muscle?)

6 Reason for NT? Pain?):NEUROLOGICAL LEVELSS teps 1-5 for classification as on reverse1. SENSORY 2. MOTOR R L 3. NEUROLOGICAL LEVEL OF INJURY(NLI)4. COMPLETE OR INCOMPLETE?Incomplete = Any sensory or motor function in S4-55. ASIA IMPAIRMENT SCALE (AIS)(In complete injuries only)ZONE OF PARTIALPRESERVATIONMost caudal level with any innervationSENSORY MOTOR R LREV 11/15 This form may be copied freely but should not be altered without permission from the American Spinal Injury (Upper Extremity Right)T2T3T4T5T6T7T8T9T10T11T12L1 LER(Lower Extremity Right)S2S3S4-5 MOTORKEY MUSCLESSENSORY KEY SENSORY POINTSPin Prick (PPL)Light Touch (LTL)LEFTUEL(Upper Extremity Left)T2T3T4T5T6T7T8T9T10T11T12L1 LEL(Lower Extremity Left) S2S3S4-5 Elbow flexorsWrist extensorsElbow extensorsFinger flexorsFinger abductors (little finger) Hip flexorsKnee extensorsAnkle dorsiflexorsLong toe extensorsAnkle plantar flexorsC2C3C4C2C3C4(DAP)

7 Deep Anal Pressure (Yes/No)UER +UEL= UEMS TOTAL(25)(25)(50)MOTOR SUBSCORES MAXLER + LEL= LEMS TOTAL(25)(25)(50)MAXLT R + LT L = LT TOTAL(56)(56)(112)MAXSENSORY SUBSCORES MAXPPR + PPL= PP TOTAL(56)(56)(112)4 = active movement, against some resistance 5 = active movement, against full resistance5* = normal corrected for pain/disuseNT = not testableMOTOR(SCORING ON REVERSE SIDE) 0 = total paralysis 1 = palpable or visible contraction 2 = active movement, gravity eliminated 3 = active movement, against gravityRIGHT TOTALS (MAXIMUM)C5C6C7C8T1L2L3L4L5S1 LEFT TOTALS(MAXIMUM)SENSORY(SCORING ON REVERSE SIDE)0 = absent1= altered2 = normalNT = not testableINTERNATIONAL STANDARDS FOR NEUROLOGICAL CLASSIFICATION OF SPINAL CORD INJURY(ISNCSCI)Patient Name_____ Date/Time of Exam _____Examiner Name _____ Signature _____ Elbow flexorsWrist extensorsElbow extensorsFinger flexorsFinger abductors (little finger) Hip flexorsKnee extensorsAnkle dorsiflexorsLong toe extensorsAnkle plantar flexorsASIA Impairment Scale (AIS)

8 Steps in ClassificationThe following order is recommended for determining the classification of individuals with Determine sensory levels for right and left sensory level is the most caudal, intact dermatome for both pin prick and light touch Determine motor levels for right and left by the lowest key muscle function that has a grade of at least 3 (on supine testing), providing the key muscle functions represented by 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 presumed to be the same as the sensory level, if testable motor function above that level is also Determine the neurological level of injury (NLI)This refers to the most caudal segment of the cord with intact sensation and antigravity (3 or more) muscle function strength, provided that there is normal (intact) sensory and motor function rostrally NLI is the most cephalad of the sensory and motor levels determined in steps 1 and Determine whether the injury is Complete or Incomplete.

9 ( absence or presence of sacral sparing)If voluntary anal contraction = No AND all S4-5 sensory scores = 0 AND deep anal pressure = No, then injury is , injury is Determine ASIA Impairment Scale (AIS) Grade: Is injury Complete? If YES, AIS=A and can record Is injury Motor Complete? If YES, AIS=B (No=voluntary anal contraction OR motor function more than three levels below the motor level on a given side, if the patient has sensory incomplete classification) Are at least half (half or more) of the key muscles below the neurological level of injury graded 3 or better?

10 If sensation and motor function is normal in all segments, AIS=ENote: 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 Root levelShoulder: Flexion, extension, abduction, adduction, internal C5and external rotation Elbow : Supination Elbow : Pronation C6 Wrist : Flexion Finger: Flexion at proximal joint, extension. C7 Thumb: Flexion, extension and abduction in plane of thumb Finger: Flexion at MCP joint C8 Thumb: Opposition, adduction and abduction perpendicular to palmFinger: Abduction of the index finger T1 Hip: Adduction L2 Hip: External rotation L3 Hip: Extension, abduction, internal rotation L4 Knee: FlexionAnkle: Inversion and eversionToe: MP and IP extension Hallux and Toe: DIP and PIP flexion and abduction L5 Hallux: Adduction S1A = Complete.