Spinal Cord Injury SCI Scales

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Asia impairment scale (modified from Frankel)

  • A=Complete. No sensory or motor function is preserved in the sacral segments S4-S5
  • B=Incomplete. Sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-S5.
  • C=Incomplete. Motor function is preserved below the neurological level, and more than half of key muscles below the neurological level have a muscle grade less than 3.
  • D=Incomplete. Motor function is preserved below the neurological level, and at least half of key muscles below the neurological level have a muscle grade greater than or equal to 3.
  • E=Normal. Sensory and motor function is normal.

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Key Sensory Points in SCI evaluation:

  • 0 = absent
  • 1 = impaired (partial or altered appreciation, including hyperaesthesia)
  • 2 = normal
  • NT = not testable

The testing for pin sensation is usually performed with a disposable safety pin; light touch is tested with cotton. In testing for pin appreciation, the inability to distinguish between dull and sharp sensation is graded as 0

  • C2=Occipital protuberance
  • C3=Supraclavicular fossa
  • C4=Top of the acromioclavicular joint
  • C5=Lateral side of the antecubital fossa
  • C6=Thumb
  • C7=Middle finger
  • C8=Little finger
  • T1=Medial (ulnar) side of the antecubital fossa
  • T2=Apex of the axilla
  • T3=Third intercostal space (IS)*
  • T4=Fourth IS (nipple line)*
  • T5=Fifth IS (midway between T4 and T6)*
  • T6=Sixth IS (level of xiphisternum)*
  • T7=Seventh IS (midway between T6 and T8)*
  • T8=Eighth IS (midway between T6 and T10)*
  • T9=Ninth IS (midway between T8 and T10)*
  • T10=Tenth IS (umbilicus)*
  • T11=Eleventh IS (Midway between T10 and T12)*
  • T12=Inguinal ligament at mid-point
  • L1=Half the distance between T12 and L2
  • L2=Mid-anterior thigh
  • L3=Medial femoral condyle
  • L4=Medial malleolus
  • L5=Dorsum of the foot at the third metatarsal phalangeal joint
  • S1=Lateral heel
  • S2=Popliteal fossa in the mid-line
  • S3=Ischial tuberosity
  • S4-5 = Perianal area (taken as one level)

*Asterisks indicate that the point is at the mid-clavicular line

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Motor Points in SCI Evaluation:

  • C5 = Elbow flexors (biceps, brachialis)
  • C6 = Wrist extensors (extensor carpi radialis longus and brevis)
  • C7 = Elbow extensors (triceps)
  • C8 = Finger flexors (flexor digitorum profundus) to the middle finger
  • T1 = Small finger abductors (abductor digiti minimi)
  • L2 = Hip flexors (iliopsoas)
  • L3 = Knee extensors (quadriceps)
  • L4 = Ankle dorsiflexors (tibialis anterior)
  • L5 = Long toe extensors (extensor hallucis longus)
  • S1 = Ankle plantarflexors (gastrocnemius, soleus)

 

Reference:

Jr, Frederick M Maynard et al. “International Standards For Neurological And Functional Classification Of Spinal Cord Injury”. Spinal Cord 35.5 (1997): 266-274. [pdf]

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