International Standards for Spinal Cord Injury

Sep 17, 2024

Instep Online Training: International Standards for Classification of Spinal Cord Injury

Overview

  • Sponsored by: American Spinal Injury Association
  • Funded by:
    • International Spinal Cord Society
    • Medtronic
    • Craig H. Nielson Foundation
    • Christopher and Dana Reeve Foundation
  • Goal: Promote spinal cord injury knowledge, care, and research through an internet tutorial.
  • Modules:
    1. Basic Anatomy
    2. Sensory Examination
    3. Motor Examination
    4. Anal Rectal Examination
    5. Scoring, Scaling, and Classification

Module 5: Scoring, Scaling, and Classification

  • Objective: Prepare to conduct and score the international standards for spinal cord injury classification.
  • Based on the 2019 revised standards (8th edition).

Importance of Accurate Examination

  • Accurate examination is crucial for scoring, scaling, and classification.
  • Requires interpretation skills for:
    • Motor and sensory examinations
    • Neurological assessment
    • Anal rectal examination
  • Determines:
    • Motor and sensory scores
    • Neurological levels
    • Completeness of injury
    • AIS grade
    • Zone of partial preservation

Scoring Methods

Sensory Score Calculation

  • Test 28 key sensory points on both sides using:
    • Light touch
    • Sharp/dull discrimination
  • Scores:
    • 0: Absent
    • 1: Impaired
    • 2: Normal

Motor Score Calculation

  • Grade each of the 10 key muscles on both sides (0-5 scale).
  • Normal strength: Grade 5

Determining Classification

  • Six Steps:
    1. Determine sensory and motor levels on both sides.
    2. Identify the neurological level of injury (NLI).
    3. Classify injuries as complete or incomplete.
    4. Use AIS grading.
    5. Determine the zone of partial preservation (ZPP).

Neurological Level of Injury

  • Most rostral segment with intact sensation and anti-gravity muscle strength.

AIS Grading

  • A: Complete
  • B: Sensory Incomplete
  • C: Motor Incomplete (less than 3 muscle grade)
  • D: Motor Incomplete (3 or greater muscle grade)
  • E: Normal

Zone of Partial Preservation (ZPP)

  • Refers to sensory and motor function below the level of injury.

Special Cases and Considerations

  • Sensory and motor levels may differ by side.
  • Non-key muscles can influence classification in certain scenarios.
  • Special rules for classification when certain levels are weak.

Clinical and Research Implications

  • Motor scores are crucial for monitoring clinical changes and assessing intervention effectiveness in trials.

This module provides a comprehensive understanding of the scoring, scaling, and classification processes essential for spinal cord injury assessments. Understanding these standards is crucial for practitioners involved in spinal cord injury care and research.