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Home » Consumer Information » Spinal Cord Injuries

Spinal Cord Injury Assessment

Prior to World War II, a clinical scale was developed and resurrected by Frankel in the'70s to assess neurological loss due to a spinal cord injury. The scale was broken into five categories:

A = No function
B = Sensory only
C = Some sensory and motor preservation
D = Useful motor function
E = Normal

ASIA Impairment Scale

A = Complete -- no motor or sensory 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 of 3 or more.
E = Normal -- motor and sensory function are normal

The ASIA Impairment Scale followed in the footsteps of the Frankel scale but differs from its predecessor in many ways. Instead of "no function below the injury site," ASIA A is the given label for someone with no mobility or feeling functions in sacral segments S4 and S5. ASIA B is very similar to Frankel B, but necessitates the preservation of function in sacral segments S4 and S5. Categories ASIA A and ASIA B are solely based on the existence of the motor and sensory function in S4 and S5.

ASIA C and ASIA D adopted quantitative measures compared to the Frankel scale, which require clinicians to determine the level of lower limb function. Besides incorporating a subjective component to the scale, the Frankel scale also disregarded arm and hand function in victims of cervical spinal cord injury. To add more clarity, ASIA decided that someone would qualify as ASIA C if greater than 50 percent of the tested muscles received a rating of below 3/5. If they didn't pass, the patient would be deemed ASIA D.

ASIA E is intriguing because it suggests that someone can suffer a spinal cord injury without exhibiting one neurological defect that is distinguishable by a test of this sort. ASIA may not be sensitive enough to detect subtle weakness, spasticity, pain, and variations of dyesthesia that could all be caused by spinal cord injury.

All of the adjustments made to the ASIA scale drastically enhanced its dependability and consistency of categorization. Even though it made more sense, the modified definition of "complete" injury doesn't show any indication of an improvement in exposing injury severity. For instance, could there be a condition where a patient could be classified as ASIA B and be in better standing than an ASIA C or ASIA D?

The refined ASIA A classification is more apt to forecast a prognosis than the former definition in which the existence of function multiple segments below the injury location in conjunction with the loss of function below a certain site could be deduced as an incomplete spinal cord injury. The ASIA committee also devised a scale for incomplete spinal cord injuries comprised of five categories:

  • Central cord syndrome -- less mobility in upper extremities than lower extremities.
  • Brown-Sequard syndrome -- hemisection spinal cord lesion.
  • Anterior cord syndrome -- injury impacts anterior spinal tracts, including the vestibulospnal tract.
  • Conus medullaris syndrome/cauda equine syndrome -- damage to the conus or spinal roots of the cord.