| 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 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]
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).
| 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. |
History
[edit]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.[10]
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.[10]
References
[edit]- ^ Harvey 2008, p. 7.
- ^ "ASIA | History". Archived from the original on 2016-01-23. Retrieved 2016-01-05.
- ^ a b c 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. PMID 22330108.
- ^ 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. S2CID 12799339.
{{cite journal}}: CS1 maint: numeric names: authors list (link) - ^ Dimitrijevic et al. 2012, p. 12.
- ^ Affiliated Societies 13.04.2011
- ^ a b "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.
- ^ a b Weiss 2010, p. 307.
- ^ Teufack, Harrop & Ashwini 2012, p. 67.
- ^ a b Kirshblum, Steven; Botticello, Amanda; Benedetto, John; Donovan, Jayne; Marino, Ralph; Hsieh, Shelly; Wagaman, Nicole (2020-06-09). "A Comparison of Diagnostic Stability of the ASIA Impairment Scale Versus Frankel Classification Systems for Traumatic Spinal Cord Injury". Archives of Physical Medicine and Rehabilitation. 101 (9): 1556–1562. doi:10.1016/j.apmr.2020.05.016.
Bibliography
[edit]- Dimitrijevic, Milan R.; Kakulas, Byron A.; McKay, W. Barry; Vrbová, Gerta, eds. (12 January 2012). Restorative Neurology of Spinal Cord Injury. Oxford University Press, USA. ISBN 978-0-19-974650-7.
- Harvey L (2008). Management of Spinal Cord Injuries: A Guide for Physiotherapists. Elsevier Health Sciences. ISBN 978-0-443-06858-4.
- Teufack S, Harrop JS, Ashwini DS (29 October 2012). "Spinal Cord Injury Classification". In Fehlings MG, Vaccaro AR, Maxwell B (eds.). Essentials of Spinal Cord Injury: Basic Research to Clinical Practice. Thieme. ISBN 978-1-60406-727-9.
- Weiss, J.M. (15 March 2010). "Spinal cord injury". In Weiss, L.D.; Weiss, J.M.; Pobre, T. (eds.). Oxford American Handbook of Physical Medicine and Rehabilitation. Oxford University Press, USA. ISBN 978-0-19-970999-1.
External links
[edit]- American Spinal Injury Association homepage
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