F0826 International Standards for Neurological Classification of SCI Worksheet hghdg

Comments:

(scoring on reverse side)

STANDARD NEUROLOGICAL CLASSIFICATION OF SPINAL CORD INJURY

REV 03/06

Patient Name ____________________________________

Examiner Name __________________________________ Date/Time of Exam___________________

(distal phalanx of middle finger)

(little finger)

SYeleswarapuText BoxNEUEXMDT

SYeleswarapuText BoxNEUEXTM

SYeleswarapuText BoxMTRULL

SYeleswarapuText BoxMTRULT

SYeleswarapuText BoxMTRLLR

SYeleswarapuText BoxMTRLLL

SYeleswarapuText BoxMTRLLT

SYeleswarapuText BoxSENSLTR

SYeleswarapuText BoxSENSLTL

SYeleswarapuText BoxSENSPPR

SYeleswarapuText BoxSENSPPL

SYeleswarapuText BoxSENSPPT

SYeleswarapuText BoxSENSLTT

SYeleswarapuText BoxANALCONT

SYeleswarapuText BoxANALSENS

SYeleswarapuText BoxSENSLVLR

SYeleswarapuText BoxSENSLVLL

SYeleswarapuText BoxMTRLVLR

SYeleswarapuText BoxMTRLVLL

SYeleswarapuText BoxCOMPLETE

SYeleswarapuText BoxAIS

SYeleswarapuText BoxSENSZPPR

SYeleswarapuText BoxSENSZPPL

SYeleswarapuText BoxMTRZPPR

SYeleswarapuText BoxMTRZPPL

SYeleswarapuText BoxMTRULR

SYeleswarapuText BoxC5MTRR

SYeleswarapuText BoxL2MTRR

SYeleswarapuText BoxL2MTRL

SYeleswarapuText BoxC2SLTR

SYeleswarapuText BoxC2SPPL

SYeleswarapuText BoxC2SPPR

SYeleswarapuText BoxC5MTRL


SYeleswarapuText BoxT1MTRL




SYeleswarapuText BoxT1MTRR









SYeleswarapuText BoxS1MTRR

SYeleswarapuText BoxS1MTRL

SYeleswarapuText BoxC2SLTL

























SYeleswarapuText BoxT1SLTR

SYeleswarapuText BoxT1SLTL

SYeleswarapuText BoxT1SPPR

SYeleswarapuText BoxT1SPPL













































SYeleswarapuText BoxL1SLTR

SYeleswarapuText BoxL1SLTL

SYeleswarapuText BoxL1SPPR

SYeleswarapuText BoxL1SPPL

















SYeleswarapuText BoxS1SLTR

SYeleswarapuText BoxS1SLTL

SYeleswarapuText BoxS1SPPR

SYeleswarapuText BoxS1SPPL













strollingerText BoxUsed with permission of the American Spinal Injury Association: International Standards for Neurological Classification of Spinal Cord Injury, revised 2002: Atlanta, GA.

strollingerText BoxNote: It is recommended that this Data Set have two additional key variables:- SITE (to distinguish the location where the data are recorded) and- SUBJECT (to distinguish the patient/study participant)

MUSCLE GRADING0 total paralysis

1 palpable or visible contraction

2 active movement, full range ofmotion, gravity eliminated

3 active movement, full range ofmotion, against gravity

4 active movement, full range ofmotion, against gravity and providessome resistance

5 active movement, full range ofmotion, against gravity and providesnormal resistance

5* muscle able to exert, in examinersjudgement, sufficient resistance to beconsidered normal if identifiableinhibiting factors were not present

NT not testable. Patient unable to reliablyexert effort or muscle unavailable for test-ing due to factors such as immobilization,pain on effort or contracture.

ASIA IMPAIRMENT SCALE

A = Complete: No motor or sensoryfunction is preserved in the sacralsegments S4-S5.

B = Incomplete: Sensory but not motorfunction is preserved below theneurological level and includes thesacral segments S4-S5.

C = Incomplete: Motor function is pre-served below the neurologicallevel, and more than half of keymuscles below the neurologicallevel have a muscle grade less than 3.

D = Incomplete: Motor function is pre-served below the neurologicallevel, and at least half of key mus-cles below the neurological levelhave a muscle grade of 3 or more.

E = Normal: Motor and sensory func-tion are normal.

CLINICAL SYNDROMES(OPTIONAL)

Central CordBrown-SequardAnterior CordConus MedullarisCauda Equina

STEPS IN CLASSIFICATIONThe following order is recommended in determining the classificationof individuals with SCI.

1. Determine sensory levels for right and left sides.2. Determine motor levels for right and left sides.

Note: in regions where there is no myotome to test, the motor levelis presumed to be the same as the sensory level.

3. Determine the single neurological level.This is the lowest segment where motor and sensory function is nor-mal on both sides, and is the most cephalad of the sensory andmotor levels determined in steps 1 and 2.

4. Determine whether the injury is Complete or Incomplete (sacral sparing).If voluntary anal contraction = No AND all S4-5 sensory scores = 0AND any anal sensation = No, then injury is COMPLETE.Otherwise injury is incomplete.

5. Determine ASIA Impairment Scale (AIS) Grade:Is injury Complete? If YES, AIS=A Record ZPP

(For ZPP record lowest dermatome or myotome on each side with some (non-zero score) preservation)

Is injury motor incomplete? If NO, AIS=B

(Yes=voluntary anal contraction OR motor function more than three levels below the motor level on a given side.)

Are at least half of the key muscles below the (single) neurological level graded 3 or better?

AIS=C AIS=D

If sensation and motor function is normal in all segments, AIS=ENote: AIS E is used in follow up testing when an individual with adocumented SCI has recovered normal function. If at initial testingno deficits are found, the individual is neurologically intact; theASIA Impairment Scale does not apply.

NO

YES

NO YES

ClassificationofSCIBasic

Proposed8CharacterVariables:

DataElement Site Subject DateofExam TimeofExam

MotorUpperLimbTotal

Right

MotorUpperLimbTotal

Left

MotorUpperLimbTotalRight+Left

MotorLowerLimbTotal

Right

MotorLowerLimbTotal

Left

MotorLowerLimbTotalRight+Left

SensoryLightTouchTotal

Right

SensoryLightTouchTotal

Left

SensoryLightTouchTotalRight+Left

Format/Codes

Numeric(yyyymmdd)88888888NotDone99999999Unknown

Numeric(hh:mm)with24hourclock88:88NotDone99:99Unknown Numeric(025) Numeric(025) Numeric(050) Numeric(025) Numeric(025) Numeric(050) Numeric(056) Numeric(056)

Numeric(0to112)

8CharacterVariable SITE SUBJECT NEUEXMDT NEUEXTM MTRULR MTRULL MTRULT MTRLLR MTRLLL MTRLLT SENSLTR SENSLTL SENSLTT

Comments/SuggestedRevisions

Shouldbederivedfromrawdatainextendeddataset


Shouldbederivedfromrightandleftsubtotals







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Format/Codes


Numeric(hh:mm)with24hourclock88:88NotDone99:99Unknown

8CharacterVariable SITE SUBJECT NEUEXMDT NEUEXTM


SensoryPinPrickTotal

Right

SensoryPinPrickTotal

Left

SensoryPinPrickTotalRight+Left

Voluntaryanalcontraction?

Anyanalsensation?

SensoryNeurologicalLevelRight

SensoryNeurologicalLevelLeft

MotorNeurologicalLevelRight

MotorNeurologicalLevelLeft

Numeric(056) Numeric(056)Numeric(0to112)

YesNo

YesNo

SENSPPR SENSPPL SENSPPT ANALCONT ANALSENS SENSLVLR SENSLVLL MTRLVLR MTRLVLL




C01C08Cervical(C1C8)T01T12Thoracic(T1T12)L01L05Lumbar(L1L5)S01S05Sacral(S1S5)X00NormalX99UnknownorNotDone


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Format/Codes



8CharacterVariable SITE SUBJECT NEUEXMDT NEUEXTM


CompleteorIncomplete? ASIAImpairmentScale

SensoryZoneofPartial

PreservationRight

SensoryZoneofPartial

PreservationLeft

MotorZoneofPartial

PreservationRight

MotorZoneofPartial

PreservationLeft

CompleteIncomplete

ACompleteInjury.BIncomplete.CIncomplete.DIncomplete.ENormal.UUnknownornotapplicable.

COMPLETE AIS SENSZPPR SENSZPPL MTRZPPR MTRZPPLA.Complete:Sensorybutnotmotorfunctionispreservedbelowtheneurologicallevelandincludesthe

sacralsegmentsS4S5.

B.Incomplete:Sensorybutnotmotorfunctionispreservedbelowtheneurologicallevelandincludesthe

sacralsegmentsS4S5.

C.Incomplete:Motorfunctionispreservedbelowtheneurologicallevel,andmorethanhalfofkeymusclesbelowtheneurologicallevelhaveamuscle

gradelessthan3.

D.Incomplete:Motorfunctionispreservedbelowtheneurologicallevel,andatleasthalfofkeymusclesbelowtheneurologicallevelhaveamusclegradeof3

ormore.

E.Normal:Motorandsensoryfunctionarenormal.



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ClassificationofSCIExtended


DataElement Site Subject DateofExam TimeofExam MotorElbowflexorsRight MotorElbowflexorsLeft

MotorWristextensorsRight MotorWristextensorsLeft

MotorElbowextensorsRight

Format/Codes



0=totalparalysis1=palpableorvisiblecontraction2=activemovement,fullrangeofmotion,gravityeliminated3=activemovement,fullrangeofmotion,againstgravity4=activemovement,fullrangeofmotion,againstgravityandprovidessomeresistance5=activemovement,fullrangeofmotion,againstgravityandprovidesnormalresistance5*=muscleabletoexert,inexaminersjudgement,sufficientresistancetobeconsiderednormalifidentifiableinhibitingfactorswerenotpresent





8CharacterVariable SITE SUBJECT NEUEXMDT NEUEXTM C5MTRR C5MTRL C6MTRR C6MTRL C7MTRRComments/SuggestedRevisions

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Format/Codes



8CharacterVariable SITE SUBJECT NEUEXMDT NEUEXTMComments/SuggestedRevisions

MotorElbowextensorsLeftMotorFingerflexorsRight

(distalphalanxofmiddlefinger)

MotorFingerflexorsLeft(distalphalanxofmiddlefinger)

MotorFingerabductorsRight(littlefinger)

MotorFingerabductorsLeft(littlefinger)






C7MTRL C8MTRR C8MTRL T1MTRR T1MTRL

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Format/Codes




MotorHipflexorsRight MotorHipflexorsLeftMotorKneeextensors

Right MotorKneeextensorsLeftMotorAnkledorsiflexors

Right






L2MTRR L2MTRL L3MTRR L3MTRL L4MTRR

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Format/Codes




MotorAnkledorsiflexorsLeft

MotorLongtoeextensorsRight

MotorLongtoeextensorsLeft

MotorAnkleplantarflexorsRight

MotorAnkleplantarflexorsLeft






L4MTRL L5MTRR L5MTRL S1MTRR S1MTRL

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Format/Codes




SensoryLightTouchC2Right

SensoryLightTouchC2Left

SensoryPinPrickC2Right

SensoryPinPrickC2Left




0=absent1=impaired2=normalNT=nottestable







C2SLTR C2SLTL C2SPPR C2SPPL C3SLTR C3SLTL C3SPPR

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Format/Codes


















C3SPPL C4SLTR C4SLTL C4SPPR C4SPPL C5SLTR C5SLTL

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Format/Codes


















C5SPPR C5SPPL C6SLTR C6SLTL C6SPPR C6SPPL C7SLTR

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Format/Codes


















C7SLTL C7SPPR C7SPPL C8SLTR C8SLTL C8SPPR C8SPPL

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Format/Codes




SensoryLightTouchT1Right

SensoryLightTouchT1Left

SensoryPinPrickT1Right

SensoryPinPrickT1Left











T1SLTR T1SLTL T1SPPR T1SPPL T2SLTR T2SLTL T2SPPR

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Format/Codes


















T2SPPL T3SLTR T3SLTL T3SPPR T3SPPL T4SLTR T4SLTL

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Format/Codes


















T4SPPR T4SPPL T5SLTR T5SLTL T5SPPR T5SPPL T6SLTR

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Format/Codes




















T6SLTL T6SPPR T6SPPL T7SLTR T7SLTL T7SPPR T7SPPL T8SLTR

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Format/Codes





















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Format/Codes





















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Format/Codes







SensoryLightTouchL1Right

SensoryLightTouchL1Left

SensoryPinPrickL1Right

SensoryPinPrickL1Left








T12SLTL T12SPPR T12SPPL L1SLTR L1SLTL L1SPPR L1SPPL

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Format/Codes




















L2SLTR L2SLTL L2SPPR L2SPPL L3SLTR L3SLTL L3SPPR L3SPPL

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Format/Codes


















L4SLTR L4SLTL L4SPPR L4SPPL L5SLTR L5SLTL L5SPPR

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Format/Codes





SensoryLightTouchS1Right

SensoryLightTouchS1Left

SensoryPinPrickS1Right

SensoryPinPrickS1Left












L5SPPL S1SLTR S1SLTL S1SPPR S1SPPL S2SLTR S2SLTL S2SPPR

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Format/Codes


















S2SPPL S3SLTR S3SLTL S3SPPR S3SPPL S45SLTR S45SLTL

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Format/Codes








S45SPPR S45SPPL

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F0826 International Standards for Neurological Classification of SCI Worksheet hghdg

Documents

datetime of exam