InStep: International Standards for the Classification of Spinal Cord Injury

Module 5: Scoring, Scaling, and Classification

Overview

• Sponsored by the American Spinal Injury Association
• Supported by:
  • International Spinal Cord Society
  • Medtronic
  • Craig H. Nielsen Foundation
  • Christopher and Dana Reeve Foundation
• Goal: Promote spinal cord injury knowledge, care, and research
• Course Series: 5 Modules
  • Basic Anatomy
  • Sensory Examination
  • Motor Examination
  • Anorectal Examination
  • Scoring, Scaling, and Classification (current module)
• Based on the 2019 revised version (8th edition of Standards)

Objectives

• Understand scoring section of the worksheet for spinal cord injury classification
• Define:
  • Neurological, sensory, and motor levels of injury
  • ASIA Impairment Scale classification
  • Zone of Partial Preservation

Examination and Scoring

• Accurate examination crucial for scoring
• Neurological assessment includes:
  • Motor and sensory examinations
  • Anorectal examination
• Forms the basis for:
  • Motor and sensory scores
  • Neurological levels
  • AIS grade
  • Zone of Partial Preservation

Sensory Score Calculation

• Test key sensory points on both sides using:
  • Light touch
  • Sharp/dull discrimination
• Scoring: 0, 1, 2
• Maximum Score: 112 for each modality

Motor Score Calculation

• Grade each of the 10 key muscles on both sides: 0-5
• Maximum Score:
  • 50 for upper limbs
  • 50 for lower limbs
• Separation into upper and lower limb scores recommended

Classification Steps

1. Determine sensory and motor levels (right and left sides)
2. Neurological level is the most rostral of these levels
3. Complete vs. Incomplete Injury
   • Complete: No sensory/motor function in S4-5
   • Incomplete: Partial preservation at S4-5

ASIA Impairment Scale (AIS)

• A: Complete injury (no sensory/motor in S4-5)
• B: Sensory incomplete
• C: Motor incomplete (less than half of muscles below injury grade 3)
• D: Motor incomplete (half or more muscles grade 3 or above)
• E: Normal (prior deficits, now resolved)

Zone of Partial Preservation (ZPP)

• Defines zones with partially preserved functions
• Used only in injuries without motor or sensory function in S4-5
• Recorded separately for right and left sides

Calculation Examples

• Sensory and motor levels
• AIS grade determination
• Zone of Partial Preservation

Conclusion

• Importance of understanding detailed examination and scoring methods for accurate classification.
• Further information and case studies available in other modules.