Spinal cord injury
ASIA Impairment Scale
The ASIA Impairment Scale is the international standard for classifying the level and completeness of a spinal cord injury, graded A through E. It is one of the most important predictors of what recovery is realistically possible, which is why it is repeated over the first weeks rather than assessed once.
Why it matters more than any other single measure
In spinal cord injury the AIS grade sets the realistic ceiling for the whole rehabilitation plan. A patient graded C has a materially different prognosis for walking than one graded A, and the programme, the equipment and the family training all follow from that grade.
Sacral sparing determines whether an injury is classified complete or incomplete, and it is the single most consequential element of the examination. Getting it wrong changes the prognosis given to a family.
Key facts
| Abbreviation | AIS |
|---|---|
| Score range | Grades A (complete) to E (normal), with motor and sensory levels |
| Time to administer | 45–60 minutes |
| Training required | Yes — formal ISNCSCI training is required |
| Cost | Free |
| Equipment | Safety pin or Wartenberg wheel · Cotton wool · Examination gloves |
| Domains | Motor function · Sensory function |
| ICF domain | Body function |
| Age range | Adult; paediatric adaptation available |
| Populations | Spinal cord injury |
| Languages | International standard, widely translated |
Psychometrics by population
The same instrument behaves differently in different conditions. A cut-off established in older adults does not transfer to Parkinson's disease, and a minimal detectable change from one study does not apply to another population.
| Population | Cut-off | MDC / MCID | Reliability | Validity |
|---|---|---|---|---|
| Spinal cord injuryExaminations in the acute phase are less reliable and must be repeated | — | — | Good reliability with trained examiners; classification errors are common without training | Early grade is closely linked to later walking recovery |
Things to be careful about
- Requires formal training — untrained classification is frequently wrong
- Sacral sparing determines complete versus incomplete and is the most consequential element
- Must be repeated, because the grade can change over the first weeks
Frequently asked questions
What do ASIA grades A to E mean?
A is a complete injury, with no motor or sensory function preserved in the lowest sacral segments. B, C and D describe increasing degrees of preserved function below the level of injury, and E means normal motor and sensory examination. The grade is recorded together with the motor and sensory levels, not on its own.
Can the grade change over time?
Yes, and this is why it is repeated rather than assessed once. Examinations in the acute phase are less reliable and the grade can change over the first weeks. A classification recorded in the first days should never be treated as the final answer, either by clinicians or by families.
What is sacral sparing and why does it matter so much?
It is whether sensation or motor function is preserved in the lowest sacral segments, and it determines whether an injury is classified complete or incomplete. That single element is the most consequential part of the examination — getting it wrong changes the prognosis given to a family.
Does the grade predict whether someone will walk again?
It is one of the most important predictors available: the grade from an early, reliable examination is closely linked to later walking recovery. In practice it sets the realistic ceiling for the whole rehabilitation plan — a patient graded C has a materially different outlook than one graded A, and the programme, the equipment and the family training all follow from it.
Can any clinician perform the classification?
It requires formal ISNCSCI training, and classification errors are common without it. The examination takes 45 to 60 minutes. If you are bringing a grade from another centre, it is worth confirming who performed it and when — an untrained classification recorded in the acute phase carries very little predictive weight.
Sources
- International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) — American Spinal Injury Association (2019)
Topic
Related instruments
- Rehabilitation outcomeFunctional Independence Measure (FIM)The FIM is an 18-item scale scoring how much assistance a person needs across thirteen motor and five cognitive tasks.
- Balance and fallsBerg Balance ScaleThe Berg Balance Scale assesses static and dynamic balance through fourteen everyday tasks, each scored 0 to 4, giving a total out of 56.
- EnduranceSix-minute walk testThe six-minute walk test records the distance a person can walk in six minutes on a flat, measured course.
