International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)

The exam has three parts. A motor examination of key muscles on both sides of the body gives an upper extremity motor score out of 50, a lower extremity motor score out of 50, and a total motor score out of 100. A sensory examination of key points across the dermatomes on both sides gives a light-touch score out of 112 and a pin-prick score out of 112. An anorectal examination records deep anal pressure and voluntary anal contraction, which decides completeness.

From these the examiner derives the motor and sensory levels on each side, the single neurological level of injury, the zone of partial preservation, and the ASIA Impairment Scale grade.

The worksheet and the scoring rules belong to the American Spinal Injury Association. This page describes the structure of the exam. To administer or score it, use the ASIA worksheet and the published standards.

Three things are reported together: the neurological level of injury, the AIS grade, and the numeric motor and sensory scores. Plain glosses of the five grades follow. The operational definitions are in the ASIA standards, and classification should be done against those.

The AIS grade is the strongest single predictor of recovery, and the motor and sensory scores are what clinical trials track. The smallest change that is clinically meaningful is about 4.5 points on the total motor score and about 5.2 on the total sensory score. The result is reference information for the care team, not a diagnosis.

Administered by

A trained clinician. Training is mandatory.

Time to administer

About 30 to 60 minutes. The expedited E-ISNCSCI reaches the level and grade in fewer steps.

Equipment

A safety pin and a tapered wisp of cotton

Position

Supine, apart from the anorectal examination, which can be done side-lying

Training required

ASIA's International Standards Training e-Learning Program (InSTeP), five modules

Cost

Free to take here.

Published by

American Spinal Injury Association (ASIA)

Available languages

Many, published by ASIA

• Spinal cord injury→

• Spinal Cord Independence Measure (SCIM III)What the person can do day to day, rather than what the nerves can do→
• GRASSPArm and hand function in detail after a cervical injury→
• Barthel IndexA shorter, older independence scale, for comparison across conditions→

Maintained by the American Spinal Injury Association with the International Spinal Cord Society. The standards were revised in 2011 and again in 2019, the eighth edition.

Intra-rater reliability

ICC 0.98 or above (Marino, 2008)

AIS grade agreement

No disagreement between two experienced examiners across 45 patients (Savic, 2007)

Repeatability

Tighter in complete injuries than incomplete ones (Marino, 2008)

Minimal clinically important difference

4.48 points total motor, 5.19 total sensory (Scivoletto 2013, via the SCIRE clinician summary)

References

1. 1.Kirshblum SC, Burns SP, Biering-Sorensen F, et al. International standards for neurological classification of spinal cord injury (revised 2011). J Spinal Cord Med. 2011;34(6):535-546.
2. 2.Rupp R, Biering-Sørensen F, Burns SP, et al. International Standards for Neurological Classification of Spinal Cord Injury: Revised 2019. Top Spinal Cord Inj Rehabil. 2021;27(2):1-22.
3. 3.Marino RJ, Jones L, Kirshblum S, Tal J, Dasgupta A. Reliability and repeatability of the motor and sensory examination of the international standards for neurological classification of spinal cord injury. J Spinal Cord Med. 2008;31(2):166-170.
4. 4.Savic G, Bergström EM, Frankel HL, Jamous MA, Jones PW. Inter-rater reliability of motor and sensory examinations performed according to American Spinal Injury Association standards. Spinal Cord. 2007;45(6):444-451.
5. 5.American Spinal Injury Association. ISNCSCI worksheet, licensing terms, and language versions.
6. 6.SCIRE Project. The American Spinal Injury Association Impairment Scale (AIS): International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). Clinician summary, version 8.2, 2025.