Motor scoring (0–5):
0=Total paralysis · 1=Palpable/visible contraction · 2=Active movement, full ROM, gravity eliminated · 3=Active movement, full ROM, against gravity · 4=Against gravity + moderate resistance · 5=Normal (full resistance) · NT=Not testable
0*, 1*, 2*, 3*, 4*, NT* = Non-SCI condition present
0=Total paralysis · 1=Palpable/visible contraction · 2=Active movement, full ROM, gravity eliminated · 3=Active movement, full ROM, against gravity · 4=Against gravity + moderate resistance · 5=Normal (full resistance) · NT=Not testable
0*, 1*, 2*, 3*, 4*, NT* = Non-SCI condition present
Upper Extremity
Level
RIGHT Muscle
R
score
score
L
LEFT Muscle
Level
UER (max 25): —
UEL (max 25): —
Lower Extremity
Level
RIGHT Muscle
R
score
score
L
LEFT Muscle
Level
LER (max 25): —
LEL (max 25): —
Sensory scoring: 0=Absent · 1=Altered (decreased/impaired or hypersensitivity) · 2=Normal · NT=Not testable ·
0*, 1*, NT* = Non-SCI condition present
LT=Light Touch (cotton wisp) · PP=Pin Prick (safety pin)
LT=Light Touch (cotton wisp) · PP=Pin Prick (safety pin)
KEY SENSORY POINTS
● Key Sensory Points
R
LTR
PPR
Lvl
LTL
PPL
LTR: —/56
PPR: —/56
LTL: —/56
PPL: —/56
Voluntary Anal Contraction (VAC)
VAC present?
Yes
No
Deep Anal Pressure (DAP)
DAP present?
Yes
No
Neurological Levels
Sensory Level (R)
Sensory Level (L)
Motor Level (R)
Motor Level (L)
NLI (Neurological Level of Injury)
Zone of Partial Preservation (ZPP) — if complete injury
Sensory ZPP (R)
Sensory ZPP (L)
Motor ZPP (R)
Motor ZPP (L)
4. Complete or Incomplete?
Injury classification
Complete
Incomplete
5. AIS Grade (manual selection)
ASIA Impairment Scale
In a patient with an apparent AIS B classification, non-key muscle functions more than 3 levels below the motor level on each side should be tested to most accurately classify the injury (differentiate between AIS B and C).
Non-Key Muscles (0–5 scale, same as key muscles)
ROOT — MOVEMENT
C5 — Shoulder flex/ext/abd/add, internal/external rotation
C6 — Elbow supination; Wrist pronation
C7 — Finger flexion (proximal); Thumb flex/ext/abd
C8 — Finger flex (MCP); Thumb opposition/add/abd ⊥
T1 — Finger abduction (index)
L2 — Hip adduction
L3 — Hip external rotation
L4 — Hip extension/abduction/internal rotation; Knee flexion; Ankle inversion/eversion
L5 — Toe MP+IP extension; Hallux+toe DIP/PIP flex/abd
S1 — Hallux adduction
C6 — Elbow supination; Wrist pronation
C7 — Finger flexion (proximal); Thumb flex/ext/abd
C8 — Finger flex (MCP); Thumb opposition/add/abd ⊥
T1 — Finger abduction (index)
L2 — Hip adduction
L3 — Hip external rotation
L4 — Hip extension/abduction/internal rotation; Knee flexion; Ankle inversion/eversion
L5 — Toe MP+IP extension; Hallux+toe DIP/PIP flex/abd
S1 — Hallux adduction
INPUT (Right / Left)
Steps in Classification (ISCSCI 2019)
1. Determine sensory levels R and L — most caudal intact dermatome for LT and PP
2. Determine motor levels R and L — lowest key muscle grade ≥3, with all above graded 5
3. Determine NLI — most cephalad of sensory and motor levels
4. Complete or Incomplete? — Complete if VAC=No AND all S4-5 sensory=0 AND DAP=No
5. Determine AIS Grade (A→E)
6. Determine ZPP — only if complete injury (no VAC and no sacral sensory)
2. Determine motor levels R and L — lowest key muscle grade ≥3, with all above graded 5
3. Determine NLI — most cephalad of sensory and motor levels
4. Complete or Incomplete? — Complete if VAC=No AND all S4-5 sensory=0 AND DAP=No
5. Determine AIS Grade (A→E)
6. Determine ZPP — only if complete injury (no VAC and no sacral sensory)
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AIS Classification Guide
A
Complete — No sensory or motor function preserved in S4-5
B
Sensory Incomplete — Sensory but not motor function below NLI, includes S4-5
C
Motor Incomplete — Motor function below NLI; >50% key muscles below NLI grade <3
D
Motor Incomplete — Motor function below NLI; ≥50% key muscles below NLI grade ≥3
E
Normal — Sensory and motor function normal; prior deficits noted